bluuebunny/crossref_metadata_2025 huggingface dataset:
Designing optimal greenhouse gas observing networks that consider performance and cost
Authors: Lucas D. D. , Yver Kwok C. , Cameron-Smith P. , Graven H. , Bergmann D. , Guilderson T. P. , Weiss R. , Keeling R.
Published: December 2014

Abstract. Emission rates of greenhouse gases (GHGs) entering into the atmosphere can be inferred using mathematical inverse approaches that combine observations from a network of stations with forward atmospheric transport models. Some locations for collecting observations are better than others for constraining GHG emissions through the inversion, but the best locations for the inversion may be inaccessible or limited by economic and other non-scientific factors. We present a method to design an optimal GHG observing network in the presence of multiple objectives that may be in conflict with each other. As a demonstration, we use our method to design a prototype network of six stations to monitor summertime emissions in California of the potent GHG 1,1,1,2-tetrafluoroethane (CH2FCF3, HFC-134a). We use a multiobjective genetic algorithm to evolve network configurations that seek to jointly maximize the scientific accuracy of the inferred HFC-134a emissions and minimize the associated costs of making the measurements. The genetic algorithm effectively determines a set of "optimal" observing networks for HFC-134a that satisfy both objectives (i.e., the Pareto frontier). The Pareto frontier is convex, and clearly shows the tradeoffs between performance and cost, and the diminishing returns in trading one for the other. Without difficulty, our method can be extended to design optimal networks to monitor two or more GHGs with different emissions patterns, or to incorporate other objectives and constraints that are important in the practical design of atmospheric monitoring networks.
Reliability, sensitivity, and uncertainty of reservoir performance under climate variability in basins with different hydrogeologic settings
Authors: Mateus C. , Tullos D.
Published: December 2014

Abstract. This study investigated how reservoir performance varied across different hydrogeologic settings and under plausible future climate scenarios. The study was conducted in the Santiam River basin, OR, USA, comparing the North Santiam basin (NSB), with high permeability and extensive groundwater storage, and the South Santiam basin (SSB), with low permeability, little groundwater storage, and rapid runoff response. We applied projections of future temperature and precipitation from global climate models to a rainfall-runoff model, coupled with a formal Bayesian uncertainty analysis, to project future inflow hydrographs as inputs to a reservoir operations model. The performance of reservoir operations was evaluated as the reliability in meeting flood management, spring and summer environmental flows, and hydropower generation objectives. Despite projected increases in winter flows and decreases in summer flows, results suggested little evidence of a response in reservoir operation performance to a warming climate, with the exception of summer flow targets in the SSB. Independent of climate impacts, historical prioritization of reservoir operations appeared to impact reliability, suggesting areas where operation performance may be improved. Results also highlighted how hydrologic uncertainty is likely to complicate planning for climate change in basins with substantial groundwater interactions.
Geospatial Approach on Landslide Hazard Zonation Mapping Using Multicriteria Decision Analysis: A Study on Coonoor and Ooty, Part of Kallar Watershed, The Nilgiris, Tamil Nadu
Authors: Abdul Rahamana S. , Aruchamy S. , Jegankumar R.
Published: December 2014

Abstract. Landslides are one of the critical natural phenomena that frequently lead to serious problems in hilly area, resulting to loss of human life and property, as well as causing severe damage to natural resources. The local geology with high degree of slope coupled with high intensity of rainfall along with unplanned human activities of the study area causes many landslides in this region. The present study area is more attracted by tourist throughout the year, so this area must be considered for preventive measures. Geospatial based Multicriteria decision analysis (MCDA) technique is increasingly used for landslide vulnerability and hazard zonation mapping. It enables the integration of different data layers with different levels of uncertainty. In this present study, it is used analytic hierarchy process (AHP) method to prepare landslide hazard zones of the Coonoor and Ooty, part of Kallar watershed, The Nilgiris, Tamil Nadu. The study was carried out using remote sensing data, field surveys and geographic information system (GIS) tools. The ten factors that influence landslide occurrence, such as elevation, slope aspect, slope angle, drainage density, lineament density, soil, precipitation, land use/land cover (LULC), distance from road and NDVI were considered. These factors layers were extracted from the various related spatial data’s. These factors were evaluated, and then, the individual factor weight and class weight were assigned to each of the related factors. The Landslide Hazard Zone Index (LHZI) was calculated using Multicriteria decision analysis (MCDA) the technique based on the assigned weight and the rating is given by the Analytical Hierarchy Process (AHP) method. The final cumulative map of the study area was categorized into four hazard zones and classified as zone I to IV. There are 3.56% of the area comes under the hazard zone IV fallowed by 48.19% of the area comes under zone III, 43.63 % of the area in zone II and 4.61% of the area comes hazard zone I. Further resulted hazard zone map and landuse/landcover map are overlaid to check the hazard status, and existing inventory of known landslides within the present study area was compared with the resulting vulnerable and hazard zone maps. The landslide hazard zonation map is useful for landslide hazard prevention, mitigation, and improvement to society, and proper planning for land use and construction in the future.
Residential self-selection in the relationships between the built environment and travel behavior: Introduction to the special issue
Authors: Cao Jason
Published: December 2014

This paper introduces the topic of residential self-selection, the topic for this issue of the Journal of Transport and Land Use.
Burgemeester en mediation
Authors: Kil Ad , de Jonge Tanja
Published: December 2014

Mayor and Mediation – Views on the Future of Mediation as a Tool in Local Public Administration

In recent years in The Netherlands around 120 mayors were trained as mediator. Focus of this multi method research was to collect the view of those mayors on – the future of - mediation as a tool in local public administration. More specific in conflicts with citizens, industry and other shareholders. Response rates on online survey was below standards but yield some descriptive aspects of this mayor group. Focus groups were informative. Mediation in local public administration is an accepted and successful phenomenon fact and will be further incorporated. Those mayors were pioneers and innovators but want to pass this method to organizational levels. One plead for incorporating principles and practice of mediation in all administrative processes and protocols.
Bemiddeling in de rechtbank van koophandel Gent
Authors: Bruggeman Maria
Published: December 2014

Mediation in the Commercial Court of Ghent

In the Commercial Court of Ghent a 5th chamber has been created in each division, with the view to proposing an alternative dispute resolution method, such as a conciliation in front of and with the assistance of the judge or a referral to an external meditation.

The author points out that files can be directed to this chamber not only at the time of introduction of the court case but also at the time the procedural calendar is set after the respondent has filed the first written submission. Even after the pleadings and after an interlocutory judgment has been rendered, the 5th chamber of the Commercial Court can still refer the matter to an external mediation.

All cases in the field of construction, internal companies disputes and commercial agency can also be automatically referred to this chamber.

The author believes that is it not the task of a judge to act as a mediator because judges are trained to decide themselves about disputes and because they do not have enough time for a mediation. However, the creation of the 5th chamber could give a boost to external mediation knowing that 75% of the attempted mediations end successfully with a settlement.
Young Adult South African Daughters’ Perceptions of Paternal Involvement and Nurturance
Authors: Wessels Sonja , Lesch Elmien
Published: December 2014

This study aimed to assess current and retrospective levels of reported and desired paternal involvement experienced by young adult daughters, as well as current and retrospective levels of paternal nurturance. A sample of 89, female, third year South African Psychology students completed self-administered questionnaires, consisting of a biographical questionnaire, four Father Involvement Scales and two Nurturant Father Scales. Daughters reported their fathers as having been involved and nurturing while growing up. Although they indicated that they perceived fathers as somewhat less involved in young adulthood; they reported being satisfied with the level of father involvement. Daughters also reported high current paternal nurturance. The findings therefore indicate that a group of middle to upper middle-class South African daughters perceived their fathers as relatively involved in their lives and suggest that their fathers’ involvement extends beyond traditional father roles.
Are Differences Between Partners Always Detrimental? The Moderating Role of Future Connectedness
Authors: Moss Simon Andrew , Dolan Jasmine
Published: December 2014

Whether perceived differences between romantic partners compromises or enhances relationships may depend on the characteristics of individuals. This study explores the possibility that differences in capabilities but not motives enhance relationship satisfaction—but only when the individuals feel connected to their future identity. In particular, when individuals feel connected to their future identity, their primary motivation is to accrue capabilities and resources that could be useful in subsequent decades. They will thus seek partners with capabilities they have yet to acquire because, consistent with self-expansion theory, they tend to perceive these abilities as part of their own self-concept. To test this premise, 152 individuals rated the motives and capabilities of both themselves and their partners and also answered questions that gauge their relationship satisfaction and connectedness to their future identity. Perceived differences in motives and capabilities were inversely associated with relationship satisfaction. However, when participants felt connected to their future identity, the inverse association between differences in capabilities and relationship satisfaction diminished. Accordingly, if individuals perceive their lives as stable, they can embrace some differences between themselves and their partner.
Boosting Energy Efficiency in Puerto Rico
Authors: Ramirez Lynnette , Robinson Dave
Published: December 2014

The Puerto Rico Aqueduct and Sewer Authority, one of North America's largest water providers, faced challenges common to the water treatment industry. Aging systems and rising energy costs across the authority's numerous water treatment and wastewater treatment plants meant year‐to‐year increases in energy costs that affected annual operating budgets. Retrofits, upgrades, and refined operation practices are bringing costs down without sacrificing service.
Donepezil 23 mg: Is it more advantageous compared to the original?
Authors: English Clayton
Published: December 2014

The acetylcholinesterase inhibitor donepezil has been in clinical use for the treatment of Alzheimer's disease since 1996. The patent on the medication expired in November 2010, and at approximately the same time, a new dosage form of donepezil was FDA approved for moderate to severe Alzheimer's disease. This article discusses the benefits and risks of the new 23 mg sustained-release dosage form compared with donepezil 10 mg, based on the clinical trial data.
Ginkgo biloba and vitamin E for Alzheimer's disease
Authors: Paxos Chris
Published: December 2014

Alzheimer's disease affects an estimated 35 million people worldwide, with over 5 million affected in the United States. Few medications are currently approved by the Food and Drug Administration (FDA) for the treatment of Alzheimer's disease; subsequently, patients and caregivers often look for additional treatment options. This article reviews studies evaluating the use of Ginkgo biloba and vitamin E for the treatment of Alzheimer's disease.
Psychopharmacology concerns in older individuals
Authors: Kutscher Eric C. , Leloux Megan R.
Published: December 2014

The geriatric population is continually growing in the United States, and the number of individuals over the age of 65 is expected to double by the year 2050. Changes in the pharmacokinetic profiles of elderly patients make appropriate medication dosing more challenging for health care providers. The Beers Criteria is a validated, consensus-based screening tool to help identify potentially inappropriate medications in geriatric patients. This article reviews recent updates to the Beers Criteria, as well as other screening tools which have been developed for this purpose.
Twice a day dosing of aripiprazole
Authors: Ayala Allen
Published: December 2014

Despite pharmacokinetic and pharmacodynamic evidence, unconventional dosing is seen in clinical practice. This article reviews data in the use of multiple daily dosing of aripiprazole, and agent with a long half-life that is indicated for once daily dosing.
Lithium in pregnancy & lactation—safer than we thought?
Authors: Wood Wende
Published: December 2014

Bipolar illness can be particularly difficult to manage in pregnancy and during the post-partum period. The risks of mood stabilizing medication on the health of the infant must be considered carefully along with the risks of uncontrolled illness in the mother. Lithium use in pregnancy and lactation has been associated with a number of negative effects in the newborn. This article reviews the latest evidence regarding the risks and benefits of the use of lithium in pregnant or lactating women.
Lithium use in bipolar disorder: Summary of evidence for acute mania, acute depression, and maintenance treatment
Authors: DeJongh Beth
Published: December 2014

Lithium has been used for more than 50 years for the treatment of bipolar disorder. There is a substantial body of literature about use of lithium in this condition, much of it with conflicting results. Many guidelines and algorithms support the use of lithium for treatment of episodes of acute mania and depression. However, additional research exploring prevention of depressive and manic relapse, treatment of acute depression, and use of combination treatments are needed.
Restless legs syndrome: Treatment overview
Authors: Patel Ankit , Patel Harshad
Published: December 2014

Restless Legs Syndrome (RLS) is a neurological movement disorder which affects a significant proportion of the general population. This article reviews the neurochemical basis and diagnosis of RLS, and reviews pharmacologic treatment options for the disorder.
Large pipeline and new safety issues likely to change 1st line recommendations for multiple sclerosis
Authors: Kamm Gayle
Published: December 2014

Multiple Sclerosis (MS) is chronic neurodegenerative disorder which can result in significant morbidity. Currently, there are not evidence-based guidelines for the choice of which first-line agent to start with, when to switch, or what to switch to, when treating MS. This review article discusses recent changes related to the treatment of MS and reviews disease modifying therapies in the pipeline for treatment of relapsing-remitting multiple sclerosis.
Assessment of a pharmacist-run medication education group for inpatient psychiatric patients
Authors: Gavin Leiha , Frey Theresa
Published: December 2014

The goal of this study was to assess the patient knowledge gained from the new pharmacist-run inpatient medication education group that was recently started on the inpatient psychiatry unit at the William S. Middleton VA Hospital in Madison, Wisconsin. The primary objective was to compare the scores from the modified Medication Understanding and Use Self-Efficacy Scale (MUSE) medication adherence tool and modified Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER) medication side effects tool between patients who attended the new group versus patients who did not attend the group. The results for the MUSE and FIBSER scores for those who attended the medication education group were slightly lower than those who did not attend the group; however, none of the scores showed any statistical differences. The medication education group on the inpatient psychiatric unit at the William S. Middleton VA was developed to increase patients' knowledge about their medications and to increase patients' access to pharmacists.
De-escalation of antipsychotic medications in an elderly patient with Alzheimer's dementia residing in an assisted living facility
Authors: Woodis C. Brock , Fuentes David , Sease Lorraine
Published: December 2014

Clinicians frequently encounter the use of antipsychotic medications in elderly patients with Alzheimer's dementia (AD). The use of these agents may be a concern since they are not approved by the Food and Drug Administration (FDA) for the treatment of AD and have been shown to increase mortality in the elderly population. This case report focuses on the gradual de-escalation of antipsychotic medications in an 80 year-old female with AD residing in an assisted living facility who was prescribed three antipsychotic medications to help manage behavioral and psychotic symptoms consistent with progressing AD. Following a request by the assisted living facility, a local family medicine practice assessed the resident's treatment regimen. A collaborative consultation between the family medicine practice's clinical pharmacist, the family medicine physician, and the health care providers at the assisted living facility resulted in the decision to gradually discontinue each antipsychotic agent at subsequent facility visits by the family medicine team.
New drugs of abuse: New threat?
Authors: Nichols Taylor
Published: December 2014

There has been an increase in the abuse of synthetic drugs. This article explores the prevalence and legal issues regarding synthetic drugs (e.g., bath salts).
Transcranial magnetic stimulation for major depressive disorder: What a pharmacist should know
Authors: Breden Crouse Ericka L.
Published: December 2014

Transcranial magnetic stimulation utilizes strong pulsed magnetic fields from an insulated coil which generate electrical currents resulting in neuronal depolarization in the cortex. Currently, the user manual only cautions against the use of tricyclic antidepressants, antipsychotics, and other medications that lower the seizure threshold during TMS therapy. However, post-marketing reports suggest caution should also be utilized when combining TMS with other antidepressants (e.g. bupropion, serotonin reuptake inhibitors) and stimulants. Data show efficacy of approximately 30%. Adverse effects more commonly reported include application site pain (35.8%), muscle twitching (20.6%), application site discomfort (10.9%), skin pain (8.5%), toothache (7.3%), facial pain (6.7%), and eye pain (6.1%).
Two case reports of smoking behavior changes after self-initiated e-cigarette use and tobacco smoking cessation
Authors: Schneiderhan Mark E.
Published: December 2014

Objective: The purpose of this report is to increase the clinician's understanding of electronic nicotine-delivery systems (ENDS) by describing similar observations of two subjects “forgetting” to use self-initiated ENDS.

Observations: A 51 year old Caucasian female with severe persistent mental illness reported continued tobacco abstinence and “forgetting” to use the ENDS at week 24 and continued tobacco abstinence beyond week 52. Also, a 42 year old Caucasian healthy male with continued tobacco abstinence and “forgetting” to use the ENDS after approximately 14 weeks remained abstinent of conventional cigarettes beyond 52 weeks.

Discussion: ENDS do not continually produce smoke like conventional cigarettes; the absence of continuous smoke may not compel the user to continue inhaling. ENDS differ from conventional cigarettes because of the on-off feature of the device, requiring the user to inhale to activate a battery-powered nicotine delivery system (atomizer).

Conclusion: Additional research is needed to verify the impact of ENDS on smoking behavior in smoking cessation. Clinicians should monitor but not yet recommend the initial use of ENDS for smoking cessation until the FDA imposes regulations on ENDS companies to ensure consistency of labeling of ingredient amounts and the overall safety of the products.
Latuda®- New dose, new do's and don'ts?
Authors: Pointer Sarah , Gonzalez Misty L.
Published: December 2014

Similar to other second-generation antipsychotics, lurasidone is an antagonist at dopamine D2 and serotonin 5HT2A receptors, and also has a high binding affinity (antagonist) for the serotonin 5HT7 receptor. Over the past several years, the dosing of this agent has changed. This article will discuss such changes and compare the efficacy, side effect rates, and cost of lurasidone dosing regimens.
Pharmacy considerations in tobacco cessation for patients suffering from posttraumatic stress disorder
Authors: Ayala Allen , Geer Melanie
Published: December 2014

Multiple studies have associated post traumatic stress disorder (PTSD) with variable and high rates of smoking documented in different populations. This article will cover the neurobiology behind tobacco use, and its implications in those with PTSD. Discussion on cessation programs (e.g., effectiveness, drug interactions), and controversy over the use of varenicline will also be discussed.
The role of propranolol for post-exposure chemoprophylaxis of posttraumatic stress disorder and acute stress disorder
Authors: Gibbs Erin N. , Cates Marshall E
Published: December 2014

Post traumatic stress disorder may be due to excessive adrenergic activation immediately following trauma leading to over-consolidation of traumatic memories. Based on this premise, propranolol has been studied as a means of post-exposure prophylaxis of posttraumatic stress disorder and acute stress disorder. Published trials include a retrospective chart review, a prospective cohort study, and a number of randomized clinical trials. Current data suggest ineffectiveness of propranolol for this indication, but larger, randomized, placebo-controlled trials that include more diverse types of traumas are needed in order to provide more definitive evidence.
Movies and mental illness: A psychiatry elective for third year pharmacy students
Authors: Jackson Cherry W.
Published: December 2014

Psychiatric illnesses are common and pharmacists need to be able to recognize the signs and symptoms of the illnesses and know how they are appropriately treated. Not all pharmacy students will have an opportunity to intern in a psychiatric setting during their fourth year, and there is not adequate time in the course of a problem based learning (PBL) therapeutics curriculum to teach many of the psychiatric illnesses and their treatment. This article describes an elective course in psychiatry offered to third-year pharmacy students, which incorporates the viewing of movies and reading of books related to psychiatric illness, in order to allow students to develop a working knowledge of basic and advanced therapeutic issues related to psychiatry and psychopharmacology.
Teaching and engaging students in large classes
Authors: Kirkwood Cynthia K.
Published: December 2014

Teaching large classes can be a challenge, especially if you are doing this for the first time. This article addresses how to approach teaching large classes and provides some strategies for promoting student engagement to facilitate learning.
Clinical considerations for the management of pediatric patients with attention-deficit/hyperactivity disorder
Authors: Linn Dustin , Murray Andrea , Smith Thomas , Fuentes David
Published: December 2014

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a chronic health condition presenting with symptoms of hyperactivity, impulsivity, and/or inattention in early childhood, adolescence and adulthood. Many patients will persist with associated symptoms throughout their life and may require long term treatment to maintain adequate control.

Objective: The purpose of this article is to review the current literature in regards to diagnosis, treatment, and management of ADHD in the pediatric and adolescent population.

Methods: A search was conducted using PubMed, Medline, Ovid, and CINHAL with a focus on studies and reviews in the English language from 2008 – 2013, featuring pediatric/adolescent patients across the ages of 4–17 years using the terms: “management”, “attention-deficit”, “hyperactivity”, and “treatment.” Literature referenced prior to the five-year time frame outlined herein provided foundational information on diagnostics and medications.

Discussion: Stimulants, in conjunction with behavioral therapy, are standard first line treatments used in ADHD. While stimulant medications have been shown to be effective in treating symptoms associated with ADHD, there are a variety of concerns that may prevent their use. These concerns are related to adverse consequences, many of which are not supported by concrete evidence. Other pharmacotherapy options such as norepinephrine reuptake inhibitors and selective alpha-2 adrenergic agonists are typically reserved as second line options. The use of novel and emerging complementary therapies will also be explored.

Conclusion: Patients diagnosed with ADHD must be thoroughly evaluated when making decisions regarding treatment. Many studies and reviews support the efficacy of pharmacotherapy in treatment of ADHD; however, there is insufficient evidence regarding long-term safety of the medications. Further research is warranted to evaluate current treatment options and associated risks and benefits to guide the clinician in optimal management of these patients.
Second generation antipsychotics & nocturnal enuresis in children
Authors: Thiel Julie
Published: December 2014

Nocturnal enuresis, or involuntary wetting during sleep, is an adverse drug reaction that may occur with numerous second generation antipsychotics (SGAs) and currently is underreported. This article reviews SGA-induced enuresis and its management.
Treatment options for Tourette syndrome
Authors: Chavez Benjamin , Cummings Veronica
Published: December 2014

Tics are commonly observed in children, and Tourette Syndrome (TS) represents one end of the spectrum of tic disorders. This article reviews the treatment options for TS.
Academic detailing: Using clinical evidence to improve care
Authors: Popish Sarah J.
Published: December 2014

Academic detailing is an educational outreach service that is effective at promoting evidence-based treatment for a given therapeutic area. This article describes what academic detailing entails, and reviews the findings of studies on the impact of academic detailing on prescribing practices.
Delirium in practice today
Authors: Canning Jacquelyn E.
Published: December 2014

Delirium occurs frequently in intensive care units (ICUs), and complicates treatment and patient outcomes. This article reviews risk factors, diagnosis, and guidelines for treatment of delirium in the ICU setting.
Antipsychotic polypharmacy and Joint Commission quality measures: Implications to the psychiatric pharmacist
Authors: Burghart Steven M.
Published: December 2014

Patients with schizophrenia commonly receive more than one antipsychotic concurrently despite little evidence to support this practice. The Joint Commission has recently implemented Hospital-Based Inpatient Psychiatric Services (HBIPS) quality measures to monitor and reduce inappropriate antipsychotic polypharmacy in patients. Pharmacists need to have a clear understanding of these quality measures and consider their role in improving appropriate antipsychotic use.
FDA pregnancy categories: Help or hindrance?
Authors: Wood Wende
Published: December 2014

In 1979, the FDA adopted the Pregnancy Category System to provide guidance regarding the risks of medication use in pregnancy; however, many shortcomings to this system have been identified. This article will review the main criticisms of the category system and discuss the new system proposed by the FDA to better convey the potential risks of medication use during pregnancy and/or lactation.
Untreated psychiatric disorder in pregnancy: Weighing the risks
Authors: Moore Thea , Pytlarz Jennifer
Published: December 2014

Though approximately 15 to 29% of pregnant patients have a psychiatric disorder during pregnancy, only about 5 to 14% seek treatment. Untreated mental illness during pregnancy has been associated with poor nutrition, failure to follow prenatal and medical guidelines, and alcohol or other substance misuse. The risks of untreated mental illness during pregnancy must be carefully evaluated along with the risks posed by medications. This review will evaluate consequences of untreated depression, anxiety, schizophrenia, and bipolar disorder in the pregnant patient.
Contraception and prenatal vitamin supplementation for women on antiepileptic medications
Authors: Williams Dorothy
Published: December 2014

This article identifies interactions among AEDs with hormonal contraceptives and summarizes management strategies from the literature. Recommendations for addressing folate, vitamin K, and vitamin D deficiency caused by AEDs are also reviewed.
Antipsychotic use during pregnancy and lactation: optimizing health for mother and newborn
Authors: Richardson Korin
Published: December 2014

This review article will evaluate the safety of antipsychotic use during pregnancy and lactation.
Aripiprazole induced hiccups
Authors: Kattura Rania , Shet Prakeh
Published: December 2014

Hiccups are a product of involuntary, intermittent spasmodic contraction of the diaphragm and inspiratory intercostal muscles that results in sudden inspiration and abrupt closure of the glottis. The exact pathophysiology of hiccups remains unknown. However, certain neurotransmitters, medications, and other factors have been implicated.

We report a case of a 38 year old patient who developed hiccups three days after adding aripiprazole 5 mg once a day to his medication regimen. Medical and environmental causes were ruled out and aripiprazole was discontinued. One day later, the hiccups resolved.

Several case reports have described patients who developed hiccups when treated with aripiprazole and related this to changes in neurotransmitter concentrations. However, due to limited literature, it was difficult to determine rate of occurrence of this adverse event with aripiprazole.

A temporal but not a causal relationship was observed between initiating aripiprazole and development of hiccups in this patient. A causal relationship cannot be established since the patient was not re-challenged with aripiprazole. Nonetheless, clinicians should be cognizant that use of aripiprazole may be associated with hiccups.
Baseline metabolic monitoring of atypical antipsychotics in an inpatient setting
Authors: Butler Phalyn , Simonson Caitlin , Goldie Christa , Kennedy Amy , Goldstone Lisa W.
Published: December 2014

Background: Atypical antipsychotic agents serve an important role in the treatment of many psychiatric disorders but have the potential to cause adverse effects, notably metabolic disturbances. These agents are known to cause increases in obesity, glucose intolerance, dyslipidemia and hypertension. In 2004, the American Diabetes Association (ADA) and the American Psychiatric Association (APA), in collaboration with other organizations, acknowledged the association between the use of atypical antipsychotics and the development of metabolic abnormalities and provided monitoring recommendations for the use of these agents. Despite these recommendations, rates of monitoring remain low.

Objective: The purpose of this study is to assess whether a pharmacist recommendation form is effective in improving baseline metabolic monitoring for patients admitted to an acute inpatient psychiatry unit who are ordered a scheduled atypical antipsychotic.

Methods: A pharmacist recommendation form with metabolic monitoring parameters was placed on the charts of patients ordered a scheduled atypical antipsychotic during a two month period. A retrospective chart review was conducted to compare the percentage of baseline monitoring ordered pre-intervention versus the intervention period. Patients ages 18 years or older who were ordered a scheduled atypical antipsychotic were included.

Results: During the intervention period, there was a significant increase in documentation for presence or absence of diabetes (p = 0.018) and cardiovascular disease (p < 0.001). A significant difference in the number of orders for hemoglobin A1c (p = 0.007) and lipid panels (p < 0.001) were noted. No other significant differences were found.

Conclusion: A pharmacist recommendation form was effective in improving the baseline monitoring of personal history of diabetes and cardiovascular disease and monitoring of hemoglobin A1c and lipid panels, but rates of other baseline monitoring parameters did not improve.
Pulmonary embolism in a patient receiving risperidone and paliperidone: A case report and review of the literature
Authors: Casey Ariane , Saitz Marianne , Swaim Paul R.
Published: December 2014

Several cases of pulmonary embolism (PE) have been associated with antipsychotic treatment. We report a case of an otherwise healthy 27-year old male who developed a PE after receiving paliperidone long acting injection. The patient received risperidone long acting injection for over 3 months before initiating paliperidone, but was switched incorrectly. After 3 weeks on paliperidone long acting injection the patient developed a PE requiring hospitalization and a course of anticoagulation. A review of atypical antipsychotic-induced venous thromboembolism is discussed.
Strategies for prevention and management of second generation antipsychotic-induced metabolic side effects
Authors: Marvanova Marketa
Published: December 2014

Preventing, minimizing and managing risks associated with second generation antipsychotic (SGA) use in patients with schizophrenia and other psychotic disorders is a priority for clinicians working with this population. Among these risks is metabolic syndrome. As this population exhibits increased rates of obesity, diabetes and atherogenic dyslipidemia compared to the general population, metabolic syndrome deserves serious consideration in patient care planning for managing risks. This article comprehensively reviews different strategies and recommendations for prevention and/or management of metabolic abnormalities associated with the use of SGAs. Baseline screening and follow-up metabolic monitoring as well as education and counseling on risk for SGA-induced weight gain and other metabolic abnormalities, physical activity and healthy diet for weight maintenance/loss should be promoted shortly after initiation of SGAs. In select patients, the clinician can consider simplifying the antipsychotic treatment regimen by switching to an agent with a lower propensity of metabolic side effects or possibly adding metformin for weight loss and glucose metabolism regulation in those experiencing a first episode of schizophrenia. Future research should focus on combinations of interventions and treatment modalities and exploration of novel interventions.
Comprehensive medication management for patients with mental illnesses
Authors: Cobb Carla
Published: December 2014

Comprehensive medication management (CMM) is a patient-care practice that aims to ensure that a patient's medication therapy is effective and safe. This article reviews pharmacist-provided CMM services, including services for psychiatric patients.
A retrospective chart review of a symptom-triggered alcohol withdrawal protocol versus previous standard of care at a veterans hospital
Authors: Zeier Katy L. , Connell Robert , Resch William , Hanson Stephen Todd , Thomas Christopher J.
Published: December 2014

Alcohol is a commonly abused substance, and it is important that healthcare facilities properly manage alcohol withdrawal. Studies have found that the most efficient way to manage alcohol withdrawal is to use a symptom-triggered approach and only administer medications if symptoms surpass a specific threshold determined by a clinician administered rating scale. Alternatively, a standard fixed-dose medication regimen can be utilized. This study assessed if a new symptom-triggered protocol, utilizing the Clinical Institute Withdrawal for Alcohol, Revised (CIWA-Ar) scale for the assessment of symptoms, resulted in the anticipated patient outcomes of decreased length of hospital stay, less benzodiazepine administered per patient, and a shorter administration time from first dose of benzodiazepine given to last dose, when compared to the previous standard of care. A retrospective chart review was performed for 70 patients who had been treated for alcohol withdrawal. Patients who were treated with the symptom-triggered protocol had a decreased length of hospital stay when compared to the previous standard of care (−2.62 days, p = 0.0054). Both secondary efficacy outcomes were also statistically significant in favor of the symptom-triggered group. This retrospective chart review adds to the body of evidence supporting the use of symptom-triggered protocols as opposed to fixed-dose protocols in the management of alcohol withdrawal.
Automatic therapeutic substitution in a psychiatric hospital
Authors: VandenBerg Amy M.
Published: December 2014

Automatic therapeutic substitution protocols have become common practice in health care systems in the last ten to fifteen years. These protocols can help formulary management, simplify pharmacy inventory, and reduce costs. To date, psychotropics continue to be absent from the most common automatic substitution policies. This article will describe the rationale for select psychotropic substitutions.
Implementation of antipsychotic selection recommendations at a veterans affairs facility
Authors: Clark Jeff , Gold Jeff , Hawk Sherri
Published: December 2014

Introduction: In 2012, the Veterans Affairs (VA) Pharmacy Benefits Management Services created recommendations for antipsychotic selection in schizophrenia and schizoaffective disorders. The recommendations stated that patients must fail two first line agents (haloperidol, loxapine, quetiapine, risperidone or perphenazine) and clozapine (if appropriate) before being allowed to trial second line agents olanzapine, ziprasidone or aripiprazole. The aim of this project was to determine the amount of cost savings that could have been provided had the above recommendations been implemented last year.

Use of second generation antipsychotics has been associated with weight gain, diabetes, and worsening lipid profiles. The American Diabetes Association (ADA) has created guidelines regarding cardiometabolic monitoring of second generation antipsychotic agents. A secondary aim of this project was to determine the rate of provider adherence to the ADA recommendations.

Methods: A retrospective chart review was performed for patients >18 years of age who were initiated on aripiprazole, ziprasidone, or olanzapine for all indications between July 1, 2011 and July 1, 2012. The costs of the mean doses of these agents were compared to an equivalent mean dose of the first line agent risperidone (4mg) using VA drug acquisition costs.

Cardiometabolic monitoring data were collected to include weight, blood pressure, fasting glucose and fasting lipid profiles at baseline and at 12 weeks.

Results: Of the 542 patients started on second line agents, only 68 met criteria for their use. A potential cost savings of over $850,000 may have been realized had these criteria been enacted within the one year time period studied.

None of the 542 patients had both baseline and follow-up values for weight, blood pressure, fasting glucose and fasting lipid profiles. While roughly 60% of patients had blood pressure and weight values at baseline and 27% had glucose and cholesterol values, less than 14% received follow-up testing with approximately 2% receiving neither baseline nor follow-up testing.

Discussion: Significant cost savings can be realized via the use of selection criteria without sacrificing efficacy as most studies do not demonstrate the superiority of one agent and the rates of adverse events between first and second generation agents are more similar than previously thought. This study also highlighted the lack of adequate cardiometabolic monitoring which could lead to cardiovascular disease.
Vilazodone: A landmark antidepressant approval or another “me-too” drug?
Authors: Farinde Abimbola
Published: December 2014

Vilazodone is a novel antidepressant which is indicated for the treatment of major depressive disorder (MDD) in adult patients. This article reviews the pharmacodynamics and pharmacokinetics of vilazodone, and discusses published and ongoing research on the medication.
Venlafaxine and duloxetine: A comparison of efficacy and tolerability for the treatment of depression in elderly patients
Authors: Franck Hugh , Potter Jonathan , Caballero Joshua
Published: December 2014

The geriatric population has a disproportionally higher rate of depression and related suicide compared to the general population. While selective serotonin reuptake inhibitors are considered first line, serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used. Online databases including MEDLINE, EMBASE, International Pharmaceutical Abstracts, and CINAHL were searched (up to June 2013) to identify trials using SNRIs in the elderly. Results revealed 15 studies involving venlafaxine (n=10) and duloxetine (n=5) use in the elderly. Overall, venlafaxine and duloxetine appear to be similar in efficacy and tolerability in treating late life depression. However, venlafaxine has been more extensively studied in this particular population, appears to carry fewer drug interactions, and is available in generic forms for regular and extended-release formulations. Doses greater than 225 mg/day for venlafaxine or 60 mg/day for duloxetine appear to lead to greater discontinuation rates.
On pens and needles: Treatment strategies for psychological insulin resistance in type 2 diabetes mellitus
Authors: Tillery Erika , Bradshaw Marquita , Ngando Ijang
Published: December 2014

Background: Psychological insulin resistance (PIR) refers to psychological opposition towards insulin therapy. Although not a formal psychological diagnosis, PIR is an under-recognized issue clinicians may encounter when treating patients with diabetes requiring insulin therapy.

Methods: Review articles, clinical trials, and practice guidelines were located using online databases. A total of 39 abstracts were reviewed and 11 articles were included in the analysis.

Results: Eleven articles were included. Proposed strategies used to mitigate the occurrence of PIR include: identifying the patient's personal obstacles via administration of PIR questionnaires, use of insulin pens as opposed to conventional syringe and needle, education on the risk of hypoglycemia and continuous emphasis of the importance of self-monitoring of blood glucose (SMBG) readings.

Discussion: The management of type 2 diabetes mellitus (T2DM) in patients requiring insulin may present challenges such as PIR. Tailoring a patient's treatment plan to account for physiological, psychological, social and financial needs may thwart some of these challenges. Other factors to consider include the cost of the agent and/or devices required. Insulin-dependent patients with T2DM should be assessed for both physiological and psychological changes.

Conclusion: Current treatment strategies for clinicians treating T2DM patients with PIR include administering the PIR or BIT questionnaire, initiating lower doses of insulin, switching from insulin vials to insulin pens, including assessment results in individualized treatment plans and using clinical outcomes to screen patients who are at risk for refusing the use of insulin. Further research evaluating clinical outcomes associated with treatment strategies is necessary.
The development of the student pharmacist chemical health scale (SPCHS)
Authors: Norton Merrill , Ford Heath , Al-Shatnawi Samah Fawzi
Published: December 2014

Background: The Student Pharmacist Chemical Health Scale (SPCHS) is a tool designed to evaluate substance use behaviors and risk factors for substance abuse among student pharmacists. Methods: It was administered to a sample of student pharmacists at the University of Georgia (UGA) as a preliminary component of a longitudinal study evaluating student pharmacists nationwide. Results: This final scale was found to have a high degree of internal consistency and showed appropriate content and face validity for the domains tested. Conclusions: Future analyses will center on further validating the SPCHS in known groups of pharmacists with substance use disorders.
Antidepressant medications: The FDA-approval process and the need for updates
Authors: Hanrahan Conor , New James P.
Published: December 2014

Antidepressant drug development first began in the mid-twentieth century with the discovery of monoamine oxidase inhibitors and tricyclic antidepressants. Soon after, additional molecular targets and drug entities were created, eventually leading to the development of selective serotonin reuptake inhibitors. Today, antidepressants now rank among the top 10 most commonly used medications in the United States (US) and account for over $11 billion in annual sales. To help ensure the safety and efficacy of these commonly used products, in 1977 the US Food and Drug Administration (FDA) created guidelines to standardize antidepressant studies and the approval process. Although many of the recommendations outlined by FDA are still relevant, the document remains vague when describing key aspects of antidepressant trial design and much of the clinical information is outdated by today's standards. This paper will provide a general overview of the FDA-approval process, summarize FDA's position related to antidepressant trial design, and discuss the need for updates in the approval process.
Clonidine and guanfacine IR vs ER: Old drugs with “new” formulations
Authors: Gormley Lyndsay , Turner Amber , Freeland Kathryn
Published: December 2014

After a long history of use for hypertension, clonidine and guanfacine have re-emerged on the market as treatment options for attention-deficit/hyperactivity disorder, particularly in patients who are unable to tolerate or need an alternative to stimulant medications as well as those who have residual symptoms despite adequate therapy with stimulants. In recent years, new formulations of long-acting clonidine and guanfacine have come to market. The purpose of this article is to review the pharmacokinetic properties and clinical utility of these new agents while comparing the medications and parent compounds in terms of dosing, adverse effects, and costs of treatment.
Orexin receptor antagonists: Novel hypnotic agents
Authors: Cooper Chandra K.
Published: December 2014

Dual acting orexin antagonists are a novel class of medications in development for the treatment of insomnia. This article reviews the available data on these agents.
Insomnia treatment for the medically ill hospitalized patient
Authors: Kelly Jennifer
Published: December 2014

Insomnia is a common sleep disorder which has been shown to adversely affect outcomes in hospitalized patients. This article reviews the available classes of medications that may be considered in the treatment of insomnia in the hospital setting.