bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Egg Surrogates to Estimate Sampling Efficiency of Striped Bass Eggs in the Savannah River
Authors: Reinert Thomas R. , Will Ted A. , Jennings Cecil A. , Davin William T.
Published: June 2004

Surface push nets have been employed in the Savannah River estuary (SRE) to monitor striped bass Morone saxatilis spawning activity since the 1960s, but most intensively since the mid-1980s. These methods provide relative catch-per-unit-effort data for comparing station-to-station and year-to-year changes in egg abundance but do not provide total annual production estimates. To quantify the sampling efficiency of our gear, we investigated the use of gellan beads as striped bass egg surrogates. Gellan beads were comparable to striped bass eggs in size and specific gravity, and are appropriate surrogates for efficiency trials. In 1999 and 2000, we released known quantities of gellan beads to evaluate the efficiency of our egg sampling gear. Efficiency ranged from 1 bead per 11,300 at large (0.009%) to about 1 bead per 300,000 at large (0.0003%), depending on release and recapture locations. The use of egg surrogates was an effective and informative technique for evaluating our standardized egg sampling gear and may be similarly useful for other systems and other species with semibuoyant pelagic eggs. Additionally, the use of egg surrogates uncovered previously unsuspected biases in sampling efficiency because of differences in channel morphology and hydrology within the SRE.
Accuracy and Precision of Age Estimates for Pallid Sturgeon from Pectoral Fin Rays
Authors: Hurley Keith L. , Sheehan Robert J. , Heidinger Roy C.
Published: June 2004

Accurate age information is critical to the biological understanding and management of most fish species, but particularly for species of concern, such as the pallid sturgeon Scaphirhynchus albus. The accuracy and precision of pallid sturgeon age estimates from pectoral fin ray sections has never been established, yet all accumulated age information for the species was collected using this technique. To examine the accuracy and precision of age estimates, 16 pectoral fin ray samples from age-6 pallid sturgeon were obtained from Gavins Point National Fish Hatchery, South Dakota. The fin rays were sectioned, mounted, and independently examined twice by each of two readers. Only 28.1% of the age estimates accurately reflected the known age of the fish. Multiple readings of the same sample by the same reader (within-reader precision) only agreed 25% of the time, differences being as great as 5 years between the two estimates. Between-reader agreement was 46.9%, the two readers' estimates of the same fish differing by as much as 2 years. Because of low accuracy and precision, estimated ages from pallid sturgeon pectoral fin rays should be viewed with caution.
Effect of Hypoxia on the Distribution of Fishes Associated with a Petroleum Platform off Coastal Louisiana
Authors: Stanley David R. , Wilson Charles A.
Published: June 2004

A combination of hydroacoustics and visual survey techniques were used to estimate the abundance, size distribution, and species composition of fishes at a petroleum platform in the northern Gulf of Mexico. The effect of dissolved oxygen (DO) concentration on the density and distribution of fishes at this de facto artificial reef was examined. The techniques used permitted surveys of the entire water column, providing a more accurate reflection of the effect of a highly variable phenomenon (i.e., hypoxia) that may not be measured with traditional fisheries sampling equipment. Hypoxic conditions were observed during two of the five trips to the petroleum platform, South Timbalier 54. When hypoxia was present, fish density was dramatically higher in the strata immediately above the hypoxia. It was difficult to determine the exact impact of hypoxia on target strength (a measure of fish size), as the larger mean target strengths observed in the spring and summer may be due to seasonal factors and not to hypoxia alone. With the exception of the fall 1995 survey (which had significantly higher density and abundance estimates than other surveys), the estimated number of fishes did not vary among any of the sample periods. Even when 32% (15–22 m) of the water column was hypoxic (summer 1996), abundance estimates were slightly higher than in other survey periods without hypoxia (except fall 1995). While hypoxia reduced the availability of the water column to fishes, they concentrated where favorable DO levels were found. This included demersal species such as red snapper Lutjanus campechanus, which were found higher in the water column than expected.
Use of Riffle and Run Habitats with Aquatic Vegetation by Juvenile Atlantic Salmon
Authors: Beland K. F. , Trial J. G. , Kocik J. F.
Published: June 2004

We examined the use of riffle and run habitats with varying aquatic macrophyte coverage by juvenile Atlantic salmon Salmo salar in the Narraguagus River, Maine, via electrofishing and individual fish observations. At the site level, large and small parr were more abundant in riffle habitats than in run habitats, and the abundance of small parr was lower at sites with heavy aquatic vegetation. At the individual-fish level, parr use of moderately vegetated areas was significantly higher than expected based on availability of such habitats, and use of heavily vegetated areas was lower than expected. The use of vegetated areas was not independent of dominant substrate type. Use of moderately vegetated habitats exceeded expectations for gravel- and sand-dominated areas; for cobble-dominated areas, use of sites with little or no vegetation exceeded expectations. Approximately 95% of the observed parr were found in the vicinity of a discrete cover item (i.e., cobble, vegetation, or other). Parr typically held position in the immediate vicinity of a cobble particle or other large stone when such cover items were available. In areas with limited cobble cover, parr often held position in the vicinity of rooted aquatic macrophytes. In the absence of cobble cover, areas with moderate levels of aquatic vegetation provide a cover component to juvenile Atlantic salmon and are used to a greater extent than similar areas lacking such cover.
Use of Resampling to Evaluate a Simple Random Sampling Design for General Monitoring of Fishes in Texas Reservoirs
Authors: Dumont Spencer C. , Schlechte Warren
Published: June 2004

Traditional formulae used to estimate sample sizes to achieve a desired level of precision have been proven to underestimate required sample sizes. Further, because these formulae typically focus on precision, they are unable to provide the information needed to evaluate the risk of not attaining other sampling objectives. Resampling approaches provide a framework for estimating realistic sample sizes, can handle complex objectives, and will provide probability-based statements that can be used to assess risk. We used a resampling approach to assess the performance of a simple random sampling design for the general monitoring of fishes with electrofishing, gill nets, and trap nets in Texas reservoirs. We evaluated median relative standard error (RSE = 100 × SE of the estimate/estimate) of catch-per-unit-effort (CPUE) estimates of stock length fish with current sampling methods. We estimated the effort necessary to achieve RSEs of (at worst) 25% or 15% (RSE25 and RSE15, respectively) at various probability levels. Resampling estimates of effort needed to achieve RSE25 were compared with estimates calculated from one commonly used formula (N = (CV/RSE)2) for all target species. Further, we estimated the effort necessary to collect 100 stock length fish of each target species. Median RSE ranged from 22 for largemouth bass Micropterus salmoides to 43 for crappies Pomoxis spp. The median number of stock length fish collected using the current sampling effort ranged from 16 for blue catfish Ictalurus furcatus to 43 for palmetto bass (male white bass Morone chrysops × female striped bass M. saxatilis) per sampling event. Estimated sampling effort needed to achieve RSE25 for largemouth bass and to collect 100 stock length largemouth bass at the 75th percentile of samples was 29 and 62 5-min stations, respectively. Estimated sampling effort needed to achieve RSE25 at the 75th percentile of samples for other target species ranged from 32 net-nights for channel catfish I. punctatus to 59 net-nights for crappies. Estimated sampling effort needed to collect 100 stock length fish from gill nets and trap nets at the 75th percentile of samples ranged from 72 net-nights for crappies to over 100 net-nights for blue catfish. Simple random sampling generally resulted in low catches of stock length fish and a poor precision of CPUE estimates, especially for target species collected with gill nets and trap nets. Sampling effort estimates (from N = (CV/RSE)2) underestimated the sampling effort needed for all species examined. Unlike traditional sample size formulae, the resampling approach presented here allows the user to determine sampling effort with an associated probability of success in achieving a particular level of precision or in collecting a given number of fish.
Summer Habitat Use by Rainbow Trout and Brown Trout in Jocassee Reservoir
Authors: Barwick D. Hugh , Foltz Jeffrey W. , Rankin Daniel M.
Published: June 2004

Temperature, dissolved oxygen, and depth preferences of Jocassee Reservoir rainbow trout Oncorhynchus mykiss and brown trout Salmo trutta implanted with temperature-sensing radio transmitters were determined during July, August, and September 1994–1998. Specific knowledge of these preferences was needed to verify habitat criteria designed to assist in the management of water quality in this reservoir for trout survival in late summer and early fall. Rainbow trout exhibited temperature, dissolved oxygen, and depth preferences in the ranges 8.3–13.4°C, 2.9–8.7 mg/L, and 30.0–52.0 m, respectively, while brown trout exhibited preferences in the ranges 7.5–21.9°C, 4.2–10.0 mg/L, and 14.0–54.0 m, respectively. Even though rainbow trout selected cooler water temperatures and greater depths than brown trout, both species generally exhibited preferences for water 20°C or cooler and containing 5.0 mg/L or more of dissolved oxygen. Maintenance of these criteria in Jocassee Reservoir should ensure adequate habitat for the summer and early fall survival of rainbow and brown trout.
Injury of American Eels Captured by Electrofishing and Trap-Netting
Authors: Reynolds James B. , Holliman F. Michael
Published: June 2004

We compared the incidence of internal injuries in adult American eels Anguilla rostrata captured by trap-netting (N = 20) and by 30-Hz, pulsed-DC electrofishing (N = 18) in the St. Lawrence River, New York. On average, the lengths and weights of fish caught by the two methods were similar. Radiographic imaging revealed that spinal damage occurred in 60% of the electroshocked American eels but only 15% of the trap-netted American eels. Bilateral filleting showed hemorrhages in 30% of the electroshocked fish but none of the trap-netted fish. Electrofishing caused significantly higher incidences of both spinal damage and hemorrhage than did trap-netting. Most electroshocked American eels had multiple spinal injuries; hemorrhages occurred only in fish with multiple sites of vertebral damage. We recommend that workers avoid the use of 30-Hz, pulsed DC to capture American eels that are intended for release; a lower frequency, such as 15 Hz, may significantly reduce injury but may also result in unacceptably low capture rates. We hypothesize that electroshocked American eels are at high risk for injury because of their large size (>90 cm) and high vertebral count (>100).
Fish Size and Exposure to Air: Potential Effects on Behavioral Impairment and Mortality Rates in Discarded Sablefish
Authors: Davis Michael W. , Parker Steven J.
Published: June 2004

Fisheries models often assume that discarded undersized fish and target species will survive and contribute to future recruitment and yield. If smaller fish are more susceptible to capture stressors than larger fish, then the assumption that smaller discards would contribute to recruitment may not be true. We tested the hypothesis that small sablefish Anoplopoma fimbria show more behavioral impairment and mortality than large fish when exposed to air (10–60 min) at various temperatures (10–18°C). Sablefish captured by trawl, longline, or trap are commonly exposed to these conditions during warmer seasons when brought up on deck and sorted. Two size-classes of fish (small: 32–49 cm total length (TL); large: 50–67 cm TL) were used in the experiments. Behavior was measured as upright orientation and startle responses to visual and mechanical stimuli 1, 2, 3, and 24 h after air exposure; mortality was measured through 7 d after air exposure. Small fish mortality increased as air time increased and was at higher levels than in large fish. Only 10 min of air exposure caused behavioral impairment in small and large fish, which could lead to increased predation on discarded fish. At 24 h after air exposure, normal behavior had not generally resumed and small fish had more behavioral impairment than large fish.
Male Dominance in the New Zealand Longfin Eel Population of a New Zealand River: Probable Causes and Implications for Management
Authors: McCleave James D. , Jellyman Donald J.
Published: June 2004

The endemic New Zealand longfin eel Anguilla dieffenbachi (hereafter, longfin eel), is overfished, and in southern South Island, New Zealand, rivers have recently become predominated by males. This study examined length and age at sexual differentiation in male eels in the Aparima River catchment (area, 1,375 km2; mean flow, 20 m3 · s−1) and the sex ratio and distribution of eels throughout the catchment. Longfin eels differentiated into males mostly at lengths from 300 to 460 mm and ages from 10 to 25+ years. Females were rare: Of 738 eels examined for sexual differentiation, 466 were males and 5 were females, and a few others, not examined, were large enough to be female. These counts suggest a male : female ratio among differentiated longfin eels of 68:1. Of 31 differentiated shortfin eels A. australis, less common in the Aparima River, 26 were females. Male longfin eels were distributed throughout the main stem and tributaries; undifferentiated eels were more prevalent in lower and middle reaches and in the main stem than in upper reaches and tributaries. In other studies, male longfin eels predominated commercial catches in the Aparima and four other southernmost rivers, by 2.4:1 to 13.6:1 males to females. The Aparima River had the most skewed sex ratio. Longfin eel catches from the Aparima River will become more male predominated because few sublegal-size females were present. The length-frequency distributions of eels in the present samples and in the commercial catches were truncated just above minimum legal size (about 460 mm), showing that few females escape the fishery. Historically, females predominated these rivers. The recent change in sex ratio is attributable partly to selective harvest of females, and partly to changes in the structure of the population from fishing, such that differentiation into males has been favored. Longevity, delayed sexual maturity, semelparity, and endemism with restricted range make the longfin eel particularly vulnerable to overfishing.
Bias and Bias Correction in Fish Recruitment Prediction
Authors: Chen D. G.
Published: June 2004

A lognormal error is usually assumed in the traditional stock–recruitment (SR) analysis. In this paper, I demonstrate that a positive bias results when an SR model with lognormal error is used for fish recruitment prediction. Not only is this bias exponentially dependent on the structure of the model's residual variance and the historical SR data, it is also dependent on the specific value of spawner biomass used. I then derive a bias correction that is asymptotically unbiased with a finite-sample bias that is practically zero. Data from two Pacific salmon populations, southeast Alaska pink salmon Oncorhynchus gorbuscha and Chilko Lake sockeye salmon O. nerka, are used to demonstrate this approach. The results show that the relative bias is about 10% for a spawning biomass within the historical range and that the bias is substantial outside that data range. However, with the proposed bias correction, the bias is negligible both within (<0.1%) and outside of (<0.3%) the data range.
Movement Patterns of American Eels in an Impounded Watercourse, as Indicated by Otolith Microchemistry
Authors: Cairns D. K. , Shiao J. C. , Iizuka Y. , Tzeng W-N. , MacPherson C. D.
Published: June 2004

Otolith Sr:Ca ratios were used to determine migrational histories of American eels Anguilla rostrata in an eastern Canadian coastal stream that is impounded at the head of tide. American eels sampled from the estuary were smaller (41.0 ± 9.3 cm (mean ± SD), N = 324) and younger (ages 1–4) than those in a freshwater pond (65.0 ± 7.5 cm, N = 265; ages 11–26) 2.5 km upstream of the head of tide. The Sr:Ca ratios permitted identification of three migrational contingents. In 7 of 13 (54%) American eels taken in the estuary, Sr:Ca ratios declined to 4.76 ± 1.22 × 10−3, indicating direct migration from the sea to estuarine settlement sites. In the 6 other American eels (46%), Sr:Ca ratios indicated an approach to freshwater soon after arrival in continental waters, followed by settlement in the estuary where ratios stabilized at 4.50 ± 1.23 × 10−3. In all 15 American eels sampled from the freshwater pond, Sr:Ca ratios indicated settlement in freshwater in the elver year and no subsequent change of habitat salinity (postelver ratio, 0.64 ± 0.66 × 10−3). The lack of evidence for postelver movements between freshwater and brackish water contrasts with literature findings that such movements are common in systems where dams do not impede access to freshwater. Dams may hamper normal American eel movements between rivers and estuaries, even in watercourses in which some American eels are able to colonize freshwaters.
Sampling Fish in Streams with Seines: Costs of Recording Data by Haul
Authors: Winston Matthew R.
Published: June 2004

Data from stream fish community samples obtained with seines are often recorded in the form of a species list with abundances, measures of total effort, and overall measures of habitat in the reach sampled. With a little more effort, investigators can significantly enhance the value of the data by recording this information for each seine haul rather than aggregating by reach. The objective of this study was to measure the added cost, in terms of time, of recording data by seine haul. While doing 11 community samples with seines, I timed four components of each seine haul: the time that the seine was in the water sampling, the time spent processing the fish, the time spent recording data for each seine haul, and the time spent getting ready for the next seine haul. I found that recording data by seine haul increased the time to make seine hauls from 8% to 34% (median of 12% or 7 min added to each hour of work). The benefits of recording data by seine haul include providing the flexibility to standardize in unforeseen circumstances, providing better quality control, and providing data at two spatial scales instead of one.
Ecological Effects of Hatchery-Reared Juvenile Chinook and Coho Salmon on Wild Juvenile Salmonids in Two Washington Streams
Authors: Riley Stephen C. , Fuss Howard J. , LeClair Larry L.
Published: June 2004

We observed wild salmonid fry at sites downstream (treatment) and upstream (control) from experimental releases of hatchery-reared Chinook salmon Oncorhynchus tshawytscha smolts and coho salmon O. kisutch fry in two streams to estimate the effects of hatchery releases on the density, group size, microhabitat use, and size of wild fish. Most hatchery-reared Chinook salmon smolts that were released left treatment sites within a few days; hatchery-reared coho salmon fry remained at treatment sites for at least several weeks. We found limited evidence to suggest that the release of hatchery-reared Chinook salmon smolts or coho salmon fry caused consistent, significant effects on the density, group size, microhabitat use, or size of wild coho salmon fry in the two streams. We observed significant decreases in the densities of wild coho salmon and trout fry (steelhead (anadromous rainbow trout) O. mykiss and cutthroat trout O. clarki combined) after hatchery-reared Chinook salmon were released, but they did not occur when large numbers of hatchery fish were present at treatment sites. We observed an increase in the group size of wild coho salmon in one stream when Chinook salmon were released, but not in the other stream. We observed few changes in microhabitat use by wild coho salmon fry associated with the release of hatchery-reared fish; most changes were observed in only a single stream or occurred after only some of the releases. The lengths and weights of wild coho salmon fry over the sampling season were not significantly different between treatment and control sites in one study stream. These results suggest that small-scale releases of hatchery-reared Chinook or coho salmon have few significant ecological effects on wild salmonid fry in small, coastal Washington streams, particularly when wild fry occur at low densities.
Factors Affecting Condition of Flannelmouth Suckers in the Colorado River, Grand Canyon, Arizona
Authors: Paukert Craig , Rogers R. Scott
Published: June 2004

The impoundment of the Colorado River by Glen Canyon Dam, Arizona, in 1963 created a highly regulated environment in the Grand Canyon that altered the native fish populations, including the flannelmouth sucker Catostomus latipinnis. Flannelmouth suckers were sampled from 1991 to 2001 to determine seasonal, annual, and spatial trends in fish condition (i.e., relative weight (Wr)). Mean Wr peaked during the prespawn and spawning periods and was lowest in summer and fall, but it was never lower than 93. Condition was variable throughout the Grand Canyon but was typically greatest at intermediate distances from Glen Canyon Dam, possibly because of the increased number of warmwater tributaries in this reach. Flannelmouth sucker condition in September was positively correlated with Glen Canyon Dam discharge during summer (June–August); this result may be due to the larger euphotic zone and greater macroinvertebrate abundance observed during higher water flows. Increased dam discharge that stimulates river productivity may provide benefits for this native fish.
Retention and Nonlethal External Detection of Calcein Marks in Rainbow Trout and Chinook Salmon
Authors: Negus Mary T. , Tureson Fred T.
Published: June 2004

An osmotic induction method was used to apply calcein marks to Chinook salmon Oncorhynchus tshawytscha and the Kamloops strain of rainbow trout O. mykiss (both migratory strains used for stocking into tributaries of Lake Superior). Preliminary exposure to a saline solution followed by immersion in a 0.5% calcein solution encouraged rapid infusion of calcein into fish tissues. Four-month-old Chinook salmon were exposed to a 1.5% or 5.0% salt solution to evaluate tolerance of different salinities and effects on mark intensity and retention. Rainbow trout were marked at three ages (2 weeks, 3.5 months, and 16 months posthatch) to evaluate the effects of age at treatment on mark intensity and long-term retention (a 5.0% preliminary salt bath was used). External detection of marks in scales, head, and fin rays was accomplished with a hand-held detector. The marking technique we used was well tolerated by both Chinook salmon and rainbow trout, and marks persisted into adulthood for rainbow trout treated at 3.5 months posthatch or later. The 5% salt concentration resulted in the persistence of more intense marks than did the 1.5% salt concentration. We demonstrated the potential applicability of calcein marks for instream population studies of migratory or anadromous species treated as fry or for studies involving release of post-fry-stage migratory or anadromous fish intended for recapture as adults.
An Economic Analysis of a Randomized, Controlled, Multicenter Study of Clinical Pharmacist Interventions for High‐Risk Veterans: The IMPROVE Study
Authors: Malone Daniel C. , Carter Barry L. , Billups Sarah J. , Valuck Robert J. , Barnette Debra J. , Sintek Charles D. , Okano Gary J. , Ellis Samuel , Covey Douglas , Mason Barbara , Jue Sandra , Carmichael Jannet , Guthrie Kelly , Sloboda Lubica , Dombrowski Robert , Geraets Douglas R. , Amato Mary G.
Published: June 2004

Study Objective. To determine if clinical pharmacists could affect economic resource use and humanistic outcomes in an ambulatory, high‐risk population.

Design. Prospective, randomized, controlled study.

Setting. Nine Veterans Affairs medical centers.

Patients. Patients who were at high risk for medication‐related problems.

Intervention. Patients were randomized to usual medical care with input from a clinical pharmacist (intervention group) or just usual medical care (control group).

Measurements and Main Results. Of 1054 patients enrolled, 523 were randomized to the intervention group and 531 to the control group. The number of clinic visits increased in the intervention group (p=0.003), but there was no difference in clinic costs. Mean increases in total health care costs were $1020 for the intervention group and $1313 for the control group (p=0.06).

Conclusion. Including the cost of pharmacist interventions, overall health care expenditures were similar for patients randomized to see a clinical pharmacist versus usual medical care.
Randomized, Placebo‐Controlled Trial of Oral Phytonadione for Excessive Anticoagulation
Authors: Patel Rachana J. , Witt Daniel M. , Saseen Joseph J. , Tillman Donald J. , Wilkinson Debra S.
Published: June 2004

Study Objective. To compare the efficacy of managing excessive anticoagulation in the absence of bleeding by either omitting warfarin therapy alone or administering oral phytonadione in addition to omitting warfarin therapy.

Design. Randomized, double‐blind, placebo‐controlled study.

Setting. Clinical pharmacy anticoagulation service in a group model health maintenance organization.

Subjects. Thirty nonbleeding patients with international normalized ratios (INRs) ranging from 6.0–10.0.

Interventions. Patients were randomized to receive either a single oral dose of phytonadione 2.5 mg or placebo. Both groups omitted warfarin doses until the INR became less than or equal to 4.0.

Measurements and Results. The mean calculated time to reach an INR of 4.0 was significantly greater in the placebo than the phytonadione group (2.6 vs 1.4 days, p=0.006). Overcorrection of anticoagulation was significantly more common in patients receiving phytonadione. Overt warfarin resistance was not observed in either group after reinitiating warfarin therapy. No major bleeding or thromboembolic complications occurred, and minor bleeding episodes were similar in both groups.

Conclusion. The addition of oral phytonadione 2.5 mg reduced the time to achieve an INR of 4.0 by approximately 1 day compared with omitting warfarin therapy alone. Adverse events did not differ between the two groups. Both strategies were effective in managing asymptomatic patients with INRs of 6.0–10.0. Oral phytonadione may be most appropriate for patients at high risk for bleeding in whom the benefit of prompt INR reduction would outweigh the thromboembolic risk associated with INR overcorrection.
Evaluation of the Half‐Life of Intravenous Human Cytomegalovirus Immune Globulin in Patients Receiving Partially Mismatched Related Donor Bone Marrow Transplantation
Authors: DeRienzo Shannon Y. , Chiang Kuang‐Yueh , O'Neal Wane M. , Godder Kamar , Abhyankar Sunil , Christiansen Neal P. , Bridges Kerry D. , Henslee‐Downey P. Jean
Published: June 2004

Study Objective. To evaluate the pharmacokinetics and use of intravenous human cytomegalovirus immune globulin (CytoGam) in allogeneic bone marrow transplantation (BMT).

Design. Prospective, nonrandomized, nonblinded, single‐center study.

Setting. University teaching hospital.

Patients. Five consecutive patients with hematologic malignancies receiving partially mismatched related donor BMT with a uniform conditioning regimen including total body irradiation and chemotherapy.

Intervention. Serum immunoglobulin and cytomegalovirus (CMV) titers were measured before and 24 hours after the first CytoGam infusion on day −6 during the conditioning regimen.

Measurements and Main Results. These levels were measured every 5 days, and a second dose was administered when the CMV titer returned to 25–50% of the 24–hour level. The half‐life of CytoGam was approximately 7 days.

Conclusion. We believe this is the first report of CytoGam's half‐life in allogeneic BMT. The information may prove vital in a future study in which the agent's potential beneficial effects can be maximized.
Hemodynamic and Cardiovascular Effects of Nitric Oxide Modulation in the Therapy of Septic Shock
Authors: Schoonover Lori L. , Stewart Angela S. , Clifton G. Dennis
Published: June 2004

Nitric oxide synthase (NOS) of the inducible subtype (iNOS) plays a pivotal role in vasodilation associated with sepsis. Various biochemical pathways are involved, revealing targets for inhibiting the consequence of iNOS activation. Interactions of transcription factors, inducers, cofactors, and regulators of iNOS are important in understanding the development of iNOS inhibitors. Inhibition through L‐arginine analogs, depletion of arginine, inhibition of cofactors, modulating gene transcription, and scavenging nitric oxide have been studied. Human studies were conducted only with nonselective L‐arginine analogs. Reduction of mortality from sepsis was not reported. It is anticipated that iNOS‐specific compounds will be clinically useful. The focus of future human trials will be on these agents. Although ideal therapy for treating vasodilation from sepsis is not available, research into the pathophysiology of NOS in sepsis clarified the complexities surrounding this therapeutic dilemma.
Clinical and Economic Effects of Pharmacy Services in a Geriatric Ambulatory Clinic
Authors: Blakey Sybelle A. , Hixson‐Wallace Julie A.
Published: June 2004

Pharmacy services were introduced in an established multidisciplinary geriatric ambulatory clinic. The pharmacist collaborated with primary care providers to optimize patients' drug regimens. Over 8 months there were 250 patient visits to the clinic. Traditional medical care was provided at 144 (57.6%) of these visits and traditional medical care plus pharmacist evaluation was provided at 106 (42.4%). The pharmacist identified 220 potential and actual drug‐related problems. Acceptance of pharmacist‐recommended changes in drug therapy was 98.6%. A mean reduction of 3.4 agents/patient was achieved in the intervention group (p<0.0001). Clinical outcomes of changes in drug therapy were neutral or positive in 99.5% of cases. Pharmacy services resulted in net savings of $7788 annually.
Phytonadione Therapy in a Multiple‐Drug Overdose Involving Warfarin
Authors: Bates Duane , Mintz Marcy
Published: June 2004

We cared for a patient who ingested an unknown amount of acetaminophen with zopiclone and warfarin. The only liver function test that was abnormal was an increased international normalized ratio (INR), which remained elevated despite treatment with subcutaneous phytonadione and a prolonged infusion of N‐acetylcysteine. An interaction between acetaminophen and warfarin may have decreased the hepatic metabolism of warfarin. The patient received numerous antibiotics that may have contributed to the increased INR. The prolonged elevation of INR also may have been due to infrequent administration of phytonadione.
Palmar‐Plantar Erythrodysesthesia Syndrome Associated with Liposomal Daunorubicin
Authors: Hui Yuk Fung , Cortes Jorge E.
Published: June 2004

Daunorubicin and doxorubicin are anthracyclines that have efficacy against malignancies such as breast cancer, lung cancer, lymphoma, and leukemia. Their adverse effects are similar. The most serious is cardiotoxicity, which often limits the total cumulative dose that can be administered. Introduction of a liposomal formulation for both agents allows tumor selectivity by accumulating the drug in tumor tissue, thus increasing the tolerated dose. Liposomal doxorubicin is commonly associated with palmar‐plantar erythrodysesthesia syndrome (PPES), although no reports of PPES were found in the literature related to liposomal daunorubicin (L‐DNR). Two patients developed PPES while receiving high‐dose L‐DNR. The symptoms were self‐limiting and resolved within a few weeks.
Anagrelide‐Induced Cardiomyopathy
Authors: James Christopher W.
Published: June 2004

Anagrelide, a selective thrombocytopenic agent, is administered to treat a variety of hematologic disorders. Despite limited clinical experience with this drug, serious cardiovascular events, including congestive heart failure, have been reported. The proposed mechanism of cardiotoxicity is attributed to inhibition of phosphodiesterase, resulting in positive inotropic activity and vasodilation. A 48‐year‐old woman with polycythemia vera developed cardiotoxicity manifested by congestive heart failure and palpitations. It was suspected to be temporally related to titrating dosages of anagrelide.
The Role of the Renin‐Angiotensin‐Aldosterone System in the Management of Heart Failure
Authors: Rodgers Jo E. , Patterson J. Herbert
Published: June 2004

Numerous clinical trials have highlighted the role of the renin‐angiotensin‐aldosterone (RAA) system in the development and progression of heart failure. Over 30 randomized, controlled trials have evaluated the effects of angiotensin‐converting enzyme (ACE) inhibitors on morbidity and mortality in over 7000 patients with heart failure. Cumulative evidence from these trials shows that these agents significantly reduce mortality and hospitalizations, slow disease progression, and improve exercise tolerance and New York Heart Association class. The Heart Failure Society of America guidelines recommend ACE inhibitors as standard therapy for patients with left ventricular systolic dysfunction. The angiotensin receptor blockers and spironolactone offer alternative and perhaps complimentary mechanisms by which the RAA system may be therapeutically manipulated. The role of these therapies in treating heart failure is discussed.
Managing Antiinfective Therapy of Community‐Acquired Pneumonia in the Hospital Setting: Focus on Switch Therapy
Authors: Ramirez Julio A.
Published: June 2004

Targeting patients for early switch from intravenous to oral antibiotic therapy and early hospital discharge is an important strategy in the management of community‐acquired pneumonia (CAP). This strategy can reduce costs due to drug administration and length of hospital stay. We show that switch therapy can be implemented safely when four criteria are met: cough and respiratory distress improve, fever abates for at least 8 hours, white blood cell count is returning to normal, and patient can take drugs orally. In prospective clinical studies conducted at our institution, the clinical cure rate with switch therapy was 99%, and mean length of hospital stay was reduced by more than 2 days. Early switch, coupled with hospital discharge, may be possible in nearly half of all CAP patients. Universal use of switch therapy in the United States could result in the total reduction of about 440,000 hospital days annually and an overall savings of $400 million.
Intravenous‐to‐Oral Transition Therapy in Community‐Acquired Pneumonia: The INOVA Health System Experience
Authors: Milkovich Gary
Published: June 2004

Economic pressures on the delivery of health care have necessitated a focus on reducing costs and resource utilization while maintaining or improving the quality of care. A growing consensus holds that switching from intravenous to oral therapy is a cost‐effective and clinically sound approach for a significantly large group of patients with community‐acquired pneumonia (CAP). Drug utilization studies within the INOVA Health System revealed that levofloxacin is a cost‐effective alternative to ciprofloxacin in infectious disease and that use of risk prediction criteria can reduce inappropriate hospitalizations for CAP, thereby reducing costs. In addition, the INOVA experience demonstrates that the strategy used to implement new antibiotic regimens such as switch‐therapy regimens is an important factor in cost reduction: a therapeutic interchange mandate is more successful than standard educational techniques in changing treatment patterns.
Suspected Allopurinol‐Induced Aseptic Meningitis
Authors: Greenberg Laurie E. , Nguyen Thuy , Miller Susan M.
Published: June 2004

Drug‐induced aseptic meningitis is a syndrome with symptoms similar to those of infectious meningitis. A 60‐year‐old man with a history of recurrent renal stones was admitted to the hospital with fever, chills, and mental status changes after taking levofloxacin, allopurinol, and acetazolamide. No infectious source was identified. Once home, he resumed allopurinol, and within 2 hours, he experienced the same symptoms, requiring rehospitalization. He was diagnosed with suspected meningitis from an adverse drug reaction that we believe was due to allopurinol. It is important to remember, when all other causes are ruled out, that a patient's symptoms may be a drug‐induced adverse effect. Drug‐induced aseptic meningitis should be considered when patients with symptoms similar to those of infectious meningitis appear without infectious etiologies or cerebrospinal fluid pleocytosis, a suspected agent was recently started, and resolution of adverse effects occurs when the agent is withdrawn.
Pharmacokinetics of Cycloserine under Fasting Conditions and with High‐Fat Meal, Orange Juice, and Antacids
Authors: Zhu Min , Nix David E. , Adam Rodney D. , Childs James M. , Peloquin Charles A.
Published: June 2004

Study Objectives. To determine the effect of a high‐fat meal, orange juice, and antacids on absorption of a single oral dose of cycloserine and to estimate its population pharmacokinetic parameters.

Design. Randomized, four‐period, crossover study.

Setting. Clinical research center.

Patients. Twelve healthy volunteers.

Interventions. Subjects received single doses of cycloserine 500 mg after a 12‐hour fast (reference), with a high‐fat meal, with orange juice, and with antacids. They also received clofazimine 200 mg, ethionamide 500 mg, andp‐aminosalicylic acid granules 6000 mg.

Measurements and Main Results. Plasma samples were collected for 48 hours and assayed by validated high‐performance capillary electrophoresis assay. Concentration‐time data were analyzed with noncompartmental, one‐compartment, and population methods. The maximum concentration (Cmax) of cycloserine was decreased (p=0.02) by the high‐fat meal. No other statistically significant differences were observed for Cmaxand area under the curve from time zero to infinity across the four treatments. The high‐fat meal significantly (p<0.0001) delayed time to maximum concentration by 4.7 times compared with that of the reference (1.1 hr).

Conclusion. The pharmacokinetics of cycloserine were minimally affected by orange juice and antacids, whereas the high‐fat meal delayed absorption. Administering cycloserine without a high‐fat meal avoids potential alterations in the pattern of absorption.
Comparison of 24‐Hour Blood Pressure Profiles in Patients with Hypertension Who Were Switched from Amlodipine to Nisoldipine
Authors: Lenz Thomas L. , Wurdeman Richard L. , Hilleman Daniel E.
Published: June 2004

Study Objective. To compare 24‐hour blood pressure control and adverse effects in patients with essential hypertension who were switched from amlodipine to nisoldipine.

Design. Open‐label, one‐way crossover study.

Setting. Cardiac clinic and patients' homes.

Patients. Twenty‐five patients with stage I or II essential hypertension stabilized with amlodipine for at least 3 months, of whom 21 patients completed the study.

Intervention. All patients underwent 24‐hour ambulatory blood pressure monitoring while receiving amlodipine 5 or 10 mg/day. Patients then were switched to nisoldipine 10 mg/day (≥ 65 yrs old) or 20 mg/day (< 65 yrs old) and returned to the clinic at 2‐week intervals to assess cuff blood pressure, heart rate, adverse effects, and compliance. No adverse effects were experienced in 15 of the 25 patients. Lower extremity edema was the most commonly reported adverse effect (four patients). Two patients discontinued treatment because of pulmonary edema in one and chest pain in the other. Two patients were lost to follow‐up. After a mean of 10.6 weeks, repeat 24‐hour ambulatory monitoring was performed to evaluate blood pressure control with nisoldipine. Systolic and diastolic ambulatory results for daytime, nighttime, and total 24 hours were calculated. For amlodipine versus nisoldipine, no significant differences existed in any of the blood pressure parameters (p>0.05) in the 21 patients who completed the study, except for 24‐hour diastolic pressure (p<0.05); however, this latter difference was only 2 mm Hg (nisoldipine 77 mm Hg, amlodipine 75 mm Hg).

Conclusion. Both amlodipine and nisoldipine have similar 24‐hour ambulatory blood pressure profiles. The frequency of lower extremity edema was no different after the switch to nisoldipine than when the patients were taking amlodipine.
Oxcarbazepine in the Treatment of Epilepsy
Authors: Glauser Tracy A.
Published: June 2004

Oxcarbazepine is a new antiepileptic drug (AED) that has been registered in more than 50 countries worldwide since 1990 and recently received approval in the United States and the European Union. Oxcarbazepine is a keto analog of carbamazepine and has a more favorable pharmacokinetic profile. It is rapidly absorbed after oral administration and undergoes rapid and almost complete reductive metabolism to form the pharmacologically active 10‐monohydroxy derivative. Oxcarbazepine exhibits linear pharmacokinetics, no autoinduction, and minimal interaction with other AEDs. Ten controlled trials demonstrated that oxcarbazepine is safe and efficacious in the treatment of partial seizures across a wide range of ages (children to adults), situations (recent onset to treatment‐resistant epilepsy), and uses (monotherapy and adjunctive therapy). The most common treatment‐emergent adverse events are related to the central nervous system. Treatment‐emergent hyponatremia (defined as serum sodium level < 125 mEq/L) occurred in 3% of patients treated with oxcarbazepine in clinical trials. According to the efficacy and safety profile established in the controlled trials, oxcarbazepine represents an important new treatment option indicated for monotherapy and adjunctive therapy in adults with partial seizures and as adjunctive therapy in children aged 4 years or older with partial seizures. Although structurally similar to carbamazepine, significant differences exist in the pharmacokinetics, drug interaction potential, adverse‐effect profile, and dosage and titration between these two agents, and they should be considered distinct therapeutic agents.
Risk Stratification in Non‐ST Segment Elevation Acute Coronary Syndromes with Special Focus on Recent Guidelines
Authors: Mathis A. Scott , Meswani Parag , Spinler Sarah A.
Published: June 2004

Patients with unstable angina or non‐ST segment elevation (non—Q‐wave) myocardial infarction are a heterogeneous group with respect to their risk of developing clinically significant adverse events such as subsequent myocardial infarction and death. Recent guidelines promote risk stratification of these patients, targeting high‐risk patients for maximal antithrombotic and antiischemic therapy and low‐risk patients for early discharge. We reviewed current and future modalities for risk stratification of patients and the predictive value of these methods in context with available pharmacologic agents. Unfortunately, most of the data identifying a particular pharmacologic regimen as beneficial in high‐risk patients are retrospectively derived from large trials. Until prospective studies that use markers to guide therapy are available, clinicians should be familiar with the use of these risk markers and their application to the role of a given management strategy, including pharmacologic therapy.
Use of Point‐of‐Service Health Status Assessments by Community Pharmacists to Identify and Resolve Drug‐Related Problems in Patients with Musculoskeletal Disorders
Authors: Ernst Michael E. , Doucette William R. , Dedhiya Seema D. , Osterhaus Matthew C. , Kumbera Patty A. , Osterhaus Jane T. , Townsend Raymond J.
Published: June 2004

Study Objective. To determine whether community pharmacists can use point‐of‐service health status assessments to identify and resolve drug‐related problems (DRPs) in ambulatory patients with selected musculoskeletal (MSK) disorders.

Design. Twelve‐month, prospective, multicenter demonstration project.

Setting. Twelve independent community pharmacies in eastern Iowa.

Patients. Ambulatory patients with self‐reported diagnosis of osteoarthritis, rheumatoid arthritis, or low back pain.

Measurements. During quarterly pharmacy visits for 1 year, patients used touch‐screen computers to report their health status. Patients answered questions on the Short Form‐36 (SF‐36) general health survey, as well as questions assessing limitations associated with their MSK condition. Pharmacists used this data in interviewing patients to assess for DRPs.

Main Results. The study enrolled 461 patients, of whom 388 returned for the 12‐month visit. During this 1‐year period, community pharmacists identified 926 cumulative DRPs. Patients with no DRPs had significantly higher physical component summary scores on the SF‐36 (p<0.05) than patients with more than one DRP at baseline (36.2 vs 31.6), 6 months (39.2 vs 33.3), and 12 months (40.1 vs 35.4). At 12 months, actions performed by pharmacists led to resolution or improvement of 70.7% of DRPs.

Conclusion. Drug‐related problems are numerous in community‐dwelling patients with MSK disorders and correspond to decreased physical health status. Community pharmacists can use patient‐reported measures of health status to identify DRPs and initiate processes to resolve them.
Antifungal Resistance Among Candida Species
Authors: Klepser Michael E.
Published: June 2004

Isolation of Candida sp less susceptible to traditional therapies and recovery of increasingly resistant isolates during antifungal therapy are growing problems. It is important for clinicians to be aware of trends and mechanisms responsible for the expression of resistance.
Rationale for Combination Antifungal Therapy
Authors: Lewis Russell E. , Kontoyiannis Dimitrios P.
Published: June 2004

The relentless increase of invasive fungal infections and poor outcomes associated with available antifungal agents prompted the search for better therapeutic strategies. Combining antifungal drugs was recommended as a means to enhance efficacy in a variety of invasive infections including cryptococcosis, candidiasis, and aspergillosis. With the exception of cryptococcal meningitis, data from controlled clinical trials supporting such combinations are sparse. Moreover, little consensus exists regarding which combinations are synergistic or antagonistic in vitro and in vivo. Based on available data, several principles underlie these combinations.