bluuebunny/crossref_metadata_2025 huggingface dataset:
Extending the Direct Behavior Rating: An Examination of Schoolwide Behavior Ratings and Academic Engagement
Authors: Bruhn Allison , Barron Sheila , Fernando Josephine , Balint-Langel Kinga
Published: July 2017

Direct behavior ratings have been identified as a practical and feasible alternative to direct observation of behavior for monitoring behavioral progress. Despite the evidence of usability, there have been calls for further examination of direct behavior ratings using different behaviors and scales. To this end, we examined the ratings of schoolwide behavioral expectations by teachers and outside observers, as well as direct observation of academic engagement by outside observers in upper elementary school language arts classrooms. Across sessions, correlations between raters (range r = .82–.91) and between measures (range r = .64–.98) were moderate to high; significant differences between raters existed when rating students identified with negative behavior ( n = 12) as opposed to positive behavior ( n = 12). Findings are discussed in terms of implications for research and practice, limitations of the study, and the necessity for further research and development.
Transmedia Television Drama: Proliferation and Promotion of Extended Stories Online
Authors: Loads Matthew
Published: July 2017

This article reports on a study of additional transmedia content that is available online in relation to all Australian television drama productions and high rating international drama productions in a five-month period, between January and June 2012. In particular, it asks what additional material exists, and develops a typology of different types of content in order to further explain the current state of play in Australian production. The study examines extended storytelling texts developed specifically for the internet, like ‘webisodes’. It also considers other video and further content that can be based on extending the story world of a program. This article presents and examines the results of the study, arguing that this material can be seen to support the idea of an industry in transition. It finds that there are differences in approach to this type of content between public, free-to-air commercial and subscription broadcasters. Children's television programs are seen to offer the most sophisticated approach online at this time.
Murdoch Wins the Final round
Authors: Mayer Henry
Published: July 2017

A review of the Administrative Appeals Tribunal (J Morling), Re Control Investments Pty Ltd and Others (Applicants) and ABT, ALP, AJA, Justice in Broadcasting, Publishing and Broadcasting Ltd and the Commonwealth of Australia (Respondents), Nos N 80/109, 111–114, 17 December 1981, 234pp.
Documentary and the Struggle for Realisms in South Africa
Authors: Tomaselli Keyan G
Published: July 2017

Language is a prime site of ideological struggle in South Africa. The state not only defines the hegemonic construct of reality, but it perpetuates and delineates the ethnic, racial, political, historical nd geographical content of what it calls ‘national-states' and racially segregated ‘communities' which fall outside the ‘homelands’.
Developing Representations of User Pays Strategies in Nature-Based Tourism Settings
Authors: Burns Diane Lee
Published: July 2017

Content analysis of The Cairns Post and The Australian newspapers was undertaken to generate key ideas and themes on the issue of ‘user pays’ strategies. All articles referring to the strategy of user pays were selected to provide a sample of articles. Summary statistics indicated that most articles referred to tourism, presented the strategy with a negative approach, and were written from the government perspective. Priority issues that became apparent from the content analysis were: user charges, equity, environmental management, funding and taxes. These issues and other concepts relating to user pays strategies were presented to students in order to elicit word associations used to develop a similarity matrix. The similarity matrix was used to develop the social representations of user pays strategies in a multidimensional scaling model. User pays was found to be represented as a management technique for enabling effective use of natural resources. It was seen as a provider of funding for natural tourism resources and determined to have a closer relationship with tourism and host communities than other forms of charges, when they are applied in natural tourism settings.
Screening for PTSD symptoms in unaccompanied refugee minors: a test of the CRIES-8 questionnaire in routine care
Authors: Salari Raziye , Malekian Cariz , Linck Linda , Kristiansson Robert , Sarkadi Anna
Published: July 2017

Aims. The dramatic increase in the number of refugees in Europe presents a major public health challenge. The limited existing evidence indicates that the mental health needs of refugees are significant; unaccompanied refugee minors (URMs) constitute a particularly vulnerable group. In this study, we aimed to investigate whether a short questionnaire (Children’s Revised Impact of Event Scale; CRIES-8) could be used as a screening tool for PTSD symptoms in URMs, 8–18 years old, during their routine health check-up. Methods. Data were collected at the healthcare centre for asylum-seekers in Uppsala, Sweden. In total, 208 URMs completed the CRIES-8 during their health assessment. Results. The CRIES-8 was feasible to use, showed good internal consistency and its factor structure was confirmed. Children with less than four years of education often had difficulties completing the questionnaire by themselves and needed help reading the questions. Almost all the respondents were male (98%), aged 9–18 years. The majority (81%) came from Afghanistan. About 76% scored above the cut-off and therefore were considered to be at risk of PTSD. The proportion of children who screened positive did not differ based on age, country of origin or current living arrangements. Conclusions. The CRIES-8 is a useful tool in clinical settings, however, children should be provided with reading support and instructions about how to complete the questionnaire. The high number of children who screened positive for PTSD symptoms indicates the need for a more thorough mental health assessment, and early prevention/intervention programmes to address URMs’ mental health issues.
Plans for Epidemiologic Research in Primary Health Care in Denmark
Authors: Kamper-Jørgensen Finn
Published: July 2017

In Denmark health policy as well as research priorities are undergoing a gradual change. Increased emphasis has been placed on primary health care in the future. Routine epidemiologic registers in Denmark are presented briefly as well as some plans for future epidemiologic research in primary health care.
Frequent Users of Doctor Services in a Small Rural Community
Authors: Videman Tapio , Heikkilä Jorma
Published: July 2017

Thirty-six per cent of the visits to doctors in a small rural community were made by the 6% of the population having the most diseases or symptoms. About 90% of the population accounted for about one-half of the medical services provided by the Kuusamo doctors; the other half was taken up by the 10% of the inhabitants in greatest need of medical attention. Adults consulted a doctor 2.1 times a year on the average. The most common reasons for consultations were respiratory diseases (23%), diseases of the genito-urinary system (16%) and accidents (14%).
Trends in Blunt Abdominal Trauma among Hospital In-patients: Developments in a Swedish Rural District over 30 Years
Authors: Bergqvist D. , Hedelin H.
Published: July 2017

To analyse changes in background factors, injury pattern, and prognosis regarding blunt abdominal trauma in Sweden, the 30-year postwar (1946–75) development was investigated in a rural district. 396 patients were treated, showing a great increase during the last 5 years. The highest frequency was seen in patients aged 11–20 years. Abdominal trauma occurred most commonly during July and August. The growing aetiological importance of road accidents is shown. Equestrian accidents were common early in the period and again towards the end. The incidence of cerebrally confused patients increased. The organs most commonly traumatized were kidney, liver, and spleen. The frequency of multiple intra-abdominal injuries and also associated extra-abdominal injuries increased with time. There was a tendency towards shorter hospital stays. Mortality rates did not change during the period, even though injuries have become increasingly severe (judged by the Injury Severity Score). It is concluded that the improved care of patients compensated precisely for the increased severity of injuries, as reflected in mortality.
Prevalence and Management of Arterial Hypertension in a Population Sample of Swedish Women
Authors: Sigurdsson Johann A. , Bengtsson Calle
Published: July 2017

Blood pressure measurements were performed in a comprehensive population study of women in Göteborg, Sweden, which was carried out in 1968–69. Altogether 1462 women were studied in five age strata between 38 and 60 years of age. They were representative for the ages studied. The prevalence of arterial hypertension was 18%, if those with systolic blood pressure ≥ 160 mmHg or diastobolic blood pressure > 95 mmHg or both and all on antihypertensive treatment are defined as hypertensives. The percentages increased from 5% of women aged 38, to 49% of women aged 60. Out of those defined as hypertensives, 74% were not receiving antihypertensive treatment, and among those on treatment 61% had systolic blood pressures ≥ 160 mmHg or diastolic blood pressures > 95 mmHg, or both.
Statistical Prediction of Case Closure Status and Time Spent at a Rehabilitation Clinic: A Cost-Effectiveness Perspective
Authors: Foldspang Anders
Published: July 2017

Over the years there has been an increasing interest in problems concerning rational organization and consequently containment of costs within the social and health service sector. One of the possibilities consists of more precise prediction of clients' fates, and consequently more rational and specific selection of clients for social and health programmes. In this study, the case closure status of 612 clients in a Danish rehabilitation clinic has been investigated as a function of social background and health. Recommendation for continued rehabilitation or for referring the client to the labour market depended on age, marital status, occupational history, and the presence of mental illness. A considerable part of the clinic's capacity was spent on clients with poor outlooks and clients with a relatively good probability of successful rehabilitation, the probabilities being estimated on the basis of biographical and health data available before the stay at the clinic. Since the clinic has mainly diagnostic tasks, the proper client target group could be said to consist of persons with relatively uncertain rehabilitation prospects.
Social Function of Adults with Isolated Ventricular Septal Defects
Authors: Otterstad Jan Erik , Tjore Ingunn , Sundby Per
Published: July 2017

Possible long-term deterioration of social function has been studied in adults over 30 years of age with congenital, isolated ventricular septal defects (VSD). This deterioration may possibly have been caused by brain damage connected with open heart surgery performed after age 10 years. Thirty-five patients with a mean age of 39 (range 31–61) years have been followed up for an average of 15 (3–21) years when restudied after surgical repair of VSD performed at a mean age of 23 (10–51) years (Group 1). Their social status was compared with 61 non-operated subjects with basically smaller defects, mean age 43 (31–73) years, who had been followed up for an average of 14 (3–21) years. Group 1 had a higher educational level, were less stressed at work, had a higher gross income (NS) and were less physically disabled ( p<0.01). Both groups had a higher educational level than normal 40-year-old Norwegians. The percentages receiving disablement pension were 12% in group 1 and 13% in group 2. Despite a higher abortion rate (33% vs. 18%), group 1 females had a higher number of liveborn babies than those in group 2 (NS). Regular medical check-ups were attended by 45% and 60% in groups 1 and 2 respectively, and about half took antibiotics prophylactically. Unlike when initially investigated, group 1 had a better cardiac condition than group 2. Compared with the non-operated group, the operated patients had suffered no detrimental effects on their social function. We therefore advocate a liberal policy for surgical repair of VSD after age 10 years.
Income Redistribution Effect of the Swedish Sickness Allowance Insurance in a Comparison of Two Concepts of Social Class
Authors: Söderfeldt Björn , Danermark Berth , Larsson Sven
Published: July 2017

Social insurances effect income distributions between social strata. Here, insurance returns in relation to income are studied on the Swedish sickness allowance insurance, which is intended to redistribute from higher to lower social strata. Two measures of social class are used, the socio-economic classification, the official index of Sweden, and a structural class concept, which in earlier results discriminates better for material factors such as income and work conditions. The material consists of all sickness cases of 1983 for 3161 persons, sampled from insurance registers and cross-classified with registers at taxation authorities. Data on insurance returns, incomes, and occupation are used. Results clearly confirm the intended redistribution effect, but considerably clearer with the structural class concept. The effect is even stronger than intended for some strata, where the system seems to lack in implementation. The consequences for choice of class measure are finally discussed.
Incidence of the Upper Respiratory and Digestive Tract Cancers and Consumption of Alcohol and Tobacco in Denmark
Authors: Guenel Pascal , Møller Henrik , Lynge Elsebeth
Published: July 2017

To study the incidence of upper respiratory and digestive tract cancer in Denmark in relation to changes in tobacco and alcohol consumption, the incidence trends are compared to the figures for average annual consumption during the period 1943–1982. The comparison is made using relative risk estimates available from previous investigations. From the available data on alcohol and tobacco consumption, an attempt is also made to predict the future incidence trends of these cancers. Since no data on the distribution of smoking versus drinking by sex and age are available from Denmark over the study period, two hypotheses are used. It is shown that the predicted incidence is strongly dependent on the distribution of smoking and drinking, and that the existence of a group with heavy consumption of tobacco and alcohol could be responsible for very high incidences of these cancers in the near future in Denmark.
Long-Term Effect on Mother-Infant Behaviour of Extra Contact During the First Hour Post Partum. V. Follow-up at Three Years
Authors: Wiberg B. , Humble K. , de Château P.
Published: July 2017

Primiparous mothers and their infants who had had an extra 15–20 minutes skin-to-skin and suckling contact (P+) during the first hour after delivery behaved differently, had a longer duration of breast-feeding, and expressed different opinions on child rearing practices at follow-ups 36 hours, 3 and 12 months after delivery as compared with a control group (P) of primiparous mothers and their infants, who were given routine care immediately after birth. The present report is based on parts of the results of the follow-up at 3 years. Asked in retrospect more P mothers found the time together with their infants immediately after delivery to have been insufficient. More P+ children were reported to have been earlier continent during the day and also earlier stubborn than the children in the P group. The Denver Developmental Screening Test showed similar results in both groups. Catecholamine levels in the urine of extra contact mothers and their boys were found to be slightly higher than those of routine care mothers and boys. Two separate analyses of video-tapes of free play showed that mothers and children in the P+ group were smiling/laughing more often than P mothers and children. The P+ mothers were more encouraging and instructing towards their children than the P mothers. Articulated conflicts were more common in the P+ group. Regardless of the type of conflict, more conflicts in the P+ group were solved. As in earlier parts of this longitudinal study differences related to type of neonatal care were more pronounced for boy-mother than for girl-mother pairs.
Class Inequality in Health
Authors: Süderfeldt Bjürn , Danermark Berth , Larsson Sven
Published: July 2017

Measures of social class, if related to different class concepts, should differ in external consistency. External consistency depends on the character of the dependent variable. Two measures of social class are here used for independent variables, the socio-economic classification, the official index of Sweden, and a structural class concept. For dependent variables, ICD diagnose chapters, directly and in a simple grouping, are used on a material from health insurance authorities. Class inequality is measured both as to size and direction, by Gini-index and rank-order correlation, respectively. Separate analyses are made for the whole material, men and women, and doctor certified absence days. Results show clear differences between the class measures for diagnoses more closely associated to work conditions, while the measures coincide in other cases.
Estimation of partly linear additive hazards model with left-truncated and right-censored data
Authors: Afzal Arfan Raheen , Dong Cheng , Lu Xuewen
Published: July 2017

In this article, we consider an additive hazards semiparametric model for left-truncated and right-censored data where the risk function has a partly linear structure, we call it the partly linear additive hazards model. The nonlinear components are assumed to be B-splines functions, so the model can be viewed as a semiparametric model with an unknown baseline hazard function and a partly linear parametric risk function, which can model both linear and nonlinear covariate effects, hence is more flexible than a purely linear or nonlinear model. We construct a pseudo-score function to estimate the coefficients of the linear covariates and the B-spline basis functions. The proposed estimators are asymptotically normal under the assumption that the true nonlinear functions are B-spline functions whose knot locations and number of knots are held fixed. On the other hand, when the risk functions are unknown non-parametric functions, the proposed method provides a practical solution to the underlying inference problems. We conduct simulation studies to empirically examine the finite-sample performance of the proposed method and analyze a real dataset for illustration.
Comparison of serological assessments in the diagnosis of liver fibrosis in bile duct ligation mice
Authors: Xie Chengxia , Ma Bo , Wang Ning , Wan Lin
Published: July 2017

Liver fibrosis assessment is essential to make a prognosis and to determine the appropriate anti-fibrosis treatment. Non-invasive serum markers are widely studied in patients to assess liver fibrosis due to the limitations of liver biopsy. When using animal models to study the mechanism and intervention of hepatic fibrosis, serum markers might be useful for the continuous assessment of liver fibrosis in individual animals, which could avoid the influence of biological differences between individuals. However, it is unclear whether serum markers can assess hepatic fibrosis in the animal model. In the present study, we evaluated and compared the ability of four serum markers to assess liver fibrosis in bile duct ligation mice. According to the stages of liver fibrosis assessed by pathological changes, mice in this study were divided into five groups (F0, F1, F2, F3, and F4). Subsequently, four serum markers, aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4), and Forns Index, were calculated for each group. Furthermore, the correlations between serum markers and pathological stages and the ability of serological markers to evaluate liver fibrosis were analyzed. AAR, APRI, FIB-4, and Forns Index could significantly distinguish F0-2 from F3-4 mice. APRI, FIB-4, and Forns Index could detect F0-3 from F4 mice. Among these four markers, FIB-4 was the best able to distinguish ≥F2 and ≥F3, with area under the curve values of 0.882 and 0.92, respectively. Forns Index was best for diagnosing F4 with area under the curve value of 0.879. These results demonstrated that serum markers could be used for assessing liver fibrosis in bile duct ligation mice, and therefore, these markers might lead to more accurate diagnostic and therapeutic studies through continuous monitoring in individual animals.

Impact statement

The assessment of liver fibrosis is essential for making a prognosis and determining the appropriate anti-fibrosis treatment. In studies focusing on the mechanism and treatment of liver fibrosis using animal models, it would be more accurate to continuously evaluate liver fibrosis in a single animal to avoid individual biological differences. Unfortunately, it is difficult to perform continuous assessment through liver biopsy in the most commonly used rodent models. It is unclear whether serum markers, which have been used in hepatic fibrosis patients, could be used in animal models. Our results demonstrate that serum markers could be used for assessing liver fibrosis in bile duct ligation mice. This study might contribute to more accurate diagnostic and therapeutic studies through continuous monitoring in individual animals.
“Bad Luck Mutations”: DNA Mutations Are not the Whole Answer to Understanding Cancer Risk
Authors: Trosko James E. , Carruba Giuseppe
Published: July 2017

It has been proposed that many human cancers are generated by intrinsic mechanisms that produce “Bad Luck” mutations by the proliferation of organ-specific adult stem cells. There have been serious challenges to this interpretation, including multiple extrinsic factors thought to be correlated with mutations found in cancers associated with these exposures. While support for both interpretations provides some validity, both interpretations ignore several concepts of the multistage, multimechanism process of carcinogenesis, namely, (1) mutations can be generated by both “errors of DNA repair” and “errors of DNA replication,” during the “initiation” process of carcinogenesis; (2) “initiated” stem cells must be clonally amplified by nonmutagenic, intrinsic or extrinsic epigenetic mechanisms; (3) organ-specific stem cell numbers can be modified during in utero development, thereby altering the risk to cancer later in life; and (4) epigenetic tumor promoters are characterized by species, individual genetic-, gender-, developmental state-specificities, and threshold levels to be active; sustained and long-term exposures; and exposures in the absence of antioxidant “antipromoters.” Because of the inevitability of some of the stem cells generating “initiating” mutations by either “errors of DNA repair” or “errors of DNA replication,” a tumor is formed depending on the promotion phase of carcinogenesis. While it is possible to reduce our frequencies of mutagenic “initiated” cells, one can never reduce it to zero. Because of the extended period of the promotion phase of carcinogenesis, strategies to reduce the appearance of cancers must involve the interruption of the promotion of these initiated cells.
Hindsight 40 years on: An interview with Baruch Fischhoff
Authors: Klein Olivier , Hegarty Peter , Fischhoff Baruch
Published: July 2017

This article presents an interview with decision scientist Baruch Fischhoff, who pioneered research on the hindsight bias—the tendency to view an event as more predictable, inevitable or likely once it has taken place. Fischhoff traces his early research on hindsight biases, conducted in Israel in the early 1970s at the beginning of Kahneman and Tversky’s influential research program in judgment and decision making. We revisit his less-known writings about social psychologists’ attributions about the decision making of leaders regarding pivotal military decisions and Fischhoff’s own engagement in security and risk analysis after 11 September. Fischhoff distinguishes two views of past events, a historian’s sense of the past as a series of distinct events and the behavioral scientist’s view of events as falling into “equivalence classes,” allowing for meaningful predictions that outcomes of past events would replicate. We discuss the contribution of decision science to the problematic and contemporary controversies surrounding replicability in experimental social psychology.
Crammer's Corner
Authors: Sales Bryony
Published: July 2017

This article indicates that the audio consultation observation tool (Audio-COT) has recently been integrated into the ePortfolio. Please note that integration is now expected in August 2017.
Renal colic
Authors: Biyani Preetha
Published: July 2017

Renal colic is defined as ‘acute and severe loin pain caused by a urinary stone’. Renal colic is a common urological presentation with approximately 1 in 11 people receiving a diagnosis of renal colic in their lifetime. More than half of patients with renal colic will have recurrent symptoms within 5 to 10 years. This article will consider the diagnosis and management of adult renal colic in primary and secondary care, including indications for appropriate referral to secondary care and longer-term management of patients with renal colic.
Ballistic limit of aircraft engine missile impact on ultra-high-performance steel-fiber-reinforced concrete panels
Authors: Zhang T , Wu H , Zhang FJ , Fang Q , Huang T
Published: July 2017

The large commercial aircraft, especially its massive engines, would cause serious damage to the valuable infrastructures during accidental or deliberate aircraft collision. Ultra-high-performance steel-fiber-reinforced concrete possesses prominent mechanical characteristics, which has been widely used in the constructions of protective structures to resist intensive loadings. This article aims to investigate the ballistic performance of aircraft engine missile. First, a series of reduce-scaled engine model impact test on ultra-high-performance steel-fiber-reinforced concrete panels was performed, and then the panel damage modes were assessed and the perforation limit of engine missiles was obtained. Second, using the mesoscopic modeling approach of ultra-high-performance steel-fiber-reinforced concrete, the present and existing engine missile impact tests are numerically simulated with the finite element program LS-DYNA, and the panel damage, residual velocity, and deformation of engine missile are well reproduced. Finally, a modified empirical formula for predicting the ballistic limit is proposed and validated by the simulated results of aircraft engine missile impact on ultra-high-performance steel-fiber-reinforced concrete panels with various thicknesses. The derived conclusion could provide helpful reference for the design and impact resistance evaluation of protective structures.
The sharing of radiological images by professional mixed martial arts fighters on social media
Authors: Rahmani George , Joyce Cormac W , McCarthy Peter
Published: July 2017

Background

Mixed martial arts is a sport that has recently enjoyed a significant increase in popularity. This rise in popularity has catapulted many of these “cage fighters” into stardom and many regularly use social media to reach out to their fans. An interesting result of this interaction on social media is that athletes are sharing images of their radiological examinations when they sustain an injury.

Purpose

To review instances where mixed martial arts fighters shared images of their radiological examinations on social media and in what context they were shared.

Material and Methods

An Internet search was performed using the Google search engine. Search terms included “MMA,” “mixed martial arts,” “injury,” “scan,” “X-ray,” “fracture,” and “break.” Articles which discussed injuries to MMA fighters were examined and those in which the fighter themselves shared a radiological image of their injury on social media were identified.

Results

During our search, we identified 20 MMA fighters that had shared radiological images of their injuries on social media. There were 15 different types of injury, with a fracture of the mid-shaft of the ulna being the most common. The most popular social media platform was Twitter. The most common imaging modality X-ray (71%). The majority of injuries were sustained during competition (81%) and 35% of these fights resulted in a win for the fighter.

Conclusion

Professional mixed martial artists are sharing radiological images of their injuries on social media. This may be in an attempt to connect with fans and raise their profile among other fighters.
Beyond Jihad: The Pacifist Tradition in West African Islam
Authors: Azumah John
Published: July 2017

Lamin Sanneh’s book Beyond Jihad deals with the peaceful transmission of Islam in West Africa by a pacifist clerical group. The author challenges the claim that the old African kingdom of Ghana was conquered by the militant Berber Almoravids in the eleventh century. Islam was not introduced into sub-Saharan Africa through militant jihad, as generally believed. The principal agents for the dissemination of Islam in West Africa were local clerics, who used the peaceful means of accommodation and adaptation. The clerical tradition was pacifist, emphasizing learning and teaching, not war and political office.
Excessive Alar Base Resection in Rhinoplasty
Authors: Arfaj Ahmad M. Al , Obeid Amani A. , Subhan Yasin
Published: July 2017

Alar base resection is an essential part of rhinoplasty which is frequently utilized to narrow a wide nasal base or to correct excessive flaring of the lateral ala extending beyond the alar-facial groove. Multiple surgical techniques have been described in the literature including alar wedge excision, sill reduction, a combination of wedge and sill reduction, repositioning the alar insertion with a V-Y advancement flap, alar flap advancement, and multiple suturing techniques. The authors of this article propose a technique that can be used to correct excessive alar or sill reduction if encountered intraoperatively.
Retrospective Assessment of Possible Hypersensitivity Reactions to Abacavir
Authors: Segarra-Newnham Marisel , Volpp Bryan D
Published: July 2017

Objective:

To document the frequency of abacavir hypersensitivity reactions in HIV-positive patients followed in a Veterans Affairs outpatient clinic.

Methods:

Abacavir's manufacturer lists the incidence of hypersensitivity as 5%. We conducted a retrospective review of all patients in our clinic who received abacavir from January 1999 to December 1999 to document the rate of discontinuation of the drug due to possible hypersensitivity reactions. The duration of abacavir therapy, concomitant antiretrovirals, most recent CD4+ count, most recent viral load, number of antiretroviral regimens previously tried, and the number and types of new antiretrovirals started concomitant with abacavir were collected.

Results:

Of 24 patients analyzed, nine (38%) discontinued abacavir, with six (25%) having a potential hypersensitivity reaction. Four reactions were classified as probable and two as possible according to the Naranjo scale. Only one patient was hospitalized for the reaction. Patients who discontinued abacavir due to a hypersensitivity reaction had similar CD4+ counts, viral loads, and had received a similar number of antiretroviral regimens compared with patients who continued the drug. However, 67% of patients who discontinued abacavir due to a hypersensitivity reaction had at least one previously documented adverse event that led to the discontinuation of another antiretroviral, compared with 7% of the patients who continued the drug (p = 0.02).

Conclusions:

The frequency of possible hypersensitivity reactions to abacavir in patients seen in our HIV clinic is higher than the manufacturer's reported rate of 5%. These patients may be more prone to adverse reactions based on previous medication history and adverse events.
Histamine2-Receptor Antagonists Do Not Prevent Allergic Reactions
Authors: Root Thomas S. , Quan David J.
Published: July 2017

Objective:

To determine whether histamine2 (H2)-receptor antagonists are effective in the treatment of allergic reactions such as rhinitis and urticaria.

Methods:

A MEDLINE search of current literature revealed 13 journal articles for review. Literature evaluation was conducted.

Conclusions:

H2-antagonists alone did not seem to prevent allergic reactions. While further studies are needed to clearly define the mechanism of the beneficial effects seen with combined H1.- and H2-antagonist therapy, there are no convincing data to suggest that H2-antagonists used alone have any therapeutic value in the prevention of allergic rhinitis or urticaria.
Attitudes toward Pharmacy Technician Use: A Six-State Survey of Community Pharmacists
Authors: Lance Judy C. , Jang Raymond
Published: July 2017

Objective:

To determine the attitudes of community pharmacists in six states toward technician employment in their community practice and to relate the effects of these attitudes to pharmacist behavior.

Design:

Four-part mail questionnaire survey. Sections A and B dealt with pharmacist attitudes toward technicians. Section C was 22 activities common to pharmacy dispensing that pharmacists currently allow technicians to perform. Section D was respondent demographics.

Respondents:

Licensed, practicing, full-time (>32 h/wk) community pharmacists in six states (Illinois, Iowa, Maine, New York, Texas, Washington).

Methods:

Attitude scores were assessed (ANOVA analysis) by pharmacist age, daily prescription volume, practice site, current technician employment, and state laws. The collective attitude scores (A plus B) were compared with activity scores for correlation between attitude and activities.

Results:

Overall, responding pharmacists were favorable toward technician use. ANOVA disclosed significant differences for pharmacist age, prescription volume, practice site, and employment of technicians. The top four activities pharmacists allowed technicians to perform were: (1) type labels, (2) select drugs from stock, (3) count needed amount of drugs, and (4) receive refill drug orders. The four least-allowed technician activities were: (1) compound intravenous solutions, (2) verify other technicians' work, (3) provide patients with drug information, and (4) verify completed drug orders. Spearman's r, showed consistency (0.335) between attitudes and activities allowed.

Conclusions:

Pharmacists approve of technician use, are comfortable with a clinically oriented counseling role, do not feel threatened by increased technician use, are willing to accept the additional professional liability technician use brings, and favor a formally structured technician training program.
Digoxin Immune Fab Administration following an Unexplained Increase in Serum Digoxin Concentration
Authors: Aruna Augustine S. , Jue Sandra G.
Published: July 2017

Objective:

To report a case of digoxin immune Fab (DIF) administration following an unexplained increase in serum digoxin concentration in an asymptomatic patient with chronic renal failure.

Case Summary:

A 70-year-old man presented to the hospital with congestive heart failure, atrial fibrillation, chronic renal failure, and suspected digoxin toxicity. By day 3, he developed a more stable cardiac rhythm with nodal beats. His last known digoxin dose was 12 hours prior to admission. No explanation for an elevated serum digoxin concentration 48 hours after admission could be found. Despite absence of other signs of digoxin toxicity, DIF 80 mg iv was administered, and was immediately followed by 40 mg.

Discussion:

This case illustrates that elevated digoxin concentrations may be observed in patients with renal failure. These may not be true high concentrations because of the following potential factors: (1) the presence of digoxin-like factors, (2) increased biotransformation of digoxin, and (3) accumulation of metabolites that interfere with the assay. Digoxin metabolites are known to cross-react with the antibodies in commonly used digoxin immunoassays, and may be inappropriately interpreted to signal digoxin toxicity. Both the accuracy and reliability of digoxin immunoassay techniques have been questioned or challenged over the years. It is difficult to determine whether a reported toxic serum digoxin concentration represents the true concentration or cross-reactivity between digoxin metabolites and antibodies used in most digoxin immunoassays.

Data Sources:

Data collection sources included retrospective review of patient medical records, personal contact with one of the physicians involved in rendering patient care for interpretation of the electrocardiogram changes, clinical symptoms and rationale for DIF administration, and contact with the immunoassay technologist, who indicated that the fluorescence polarization immunoassay technique was used for analysis of digoxin concentrations. The medical literature then was reviewed.

Conclusions:

DIF should be reserved for use in symptomatic patients. Elevated digoxin concentrations must be evaluated for various factors that can cause falsely elevated values. Clinical signs and symptoms are critical in making the decision to use Fab. Antidotal measures should be based on correlation of patient symptoms with serum digoxin concentrations.
Phenobarbital Pharmacokinetics in Infants Using Saliva as a Biologic Fluid
Authors: Gutierrez Stella , Vázquez Marta , Amodio Amanda , Giachetto Gustavo , Moller Diana , Queirolo Mariela , Taboas Silvia , Ferrari Ana M. , Fagiolino Pietro L.
Published: July 2017

Objective:

To determine the pharmacokinetic parameters of phenobarbital in infants, using saliva as a biologic fluid, and to correlate the parameters obtained from saliva data with those obtained from plasma data.

Design:

A prospective, randomized study.

Setting:

Hospitalized patients at the Medical Center Pereira Rossell, a pediatric hospital in Montevideo, Uruguay.

Patients:

Sixteen infants with seizure disorders were included in the study. None of them was treated with other medications.

Interventions:

A direct intravenous loading dose of phenobarbital 10 mg/kg was administered, followed by a maintenance dosage of 5 mg/kg/d (once- or twice-daily dosing) given 12 hours after the loading dose.

Main Outcome Measures:

Saliva and plasma samples were obtained 6 and 12 hours after the loading dose and 3 days after the initiation of the maintenance dose (trough sample): the samples were analyzed by HPLC and the elimination half-life (t1/2), the volume of distribution (Vd), and the percentage of unbound drug in plasma (UDP) were calculated.

Results:

The t1/2 obtained from plasma and saliva data was 30 hours; the Vd was 0.73 L/kg from plasma data and 2.4 L/kg from saliva data; and the UDP was 75 percent. Trough concentrations showed no significant difference between treatments.

Conclusions:

Saliva is a useful biologic fluid to determine phenobarbital pharmacokinetic parameters, mainly in pediatric patients. Moreover, a single daily dose of phenobarbital is sufficient to obtain therapeutic concentrations.
Enalapril-Induced, Near-Fatal Angioedema
Authors: Rao Satya , MacHuga David T
Published: July 2017

Objective:

To report a near-fatal angioedema associated with the use of enalapril, a long-acting angiotensin-converting enzyme inhibitor.

Data Sources:

Medical record of the patient, case reports identified by MEDLINE.

Case Summary:

A 52-year-old man was admitted to our institution for closed reduction and debridement of an injury sustained to the left index finger. The patient's blood pressure was increased (180/102 mm Hg), and he was placed on nifedipine 60 mg and enalapril 5 mg/d. Other medications included ranitidine 150 mg bid and cefotaxime 2 g q8h. Eighteen hours after the first dose of enalapril the patient developed swelling of the face and lips and had difficulty breathing. The patient was seen initially by the house physician, who ruled out a penicillin/cephalosporin allergy. The assessment of an allergic reaction to enalapril was made and the drug was discontinued. Diphenhydramine 50 mg im, epinephrine 0.5 mL sc, and methylprednisone 125 mg iv were given immediately, and the patient was transferred to the intensive care unit (ICU). Methylprednisone 100 mg q6h was initiated along with diphenhydramine 50 mg im q6h prn. Over the next 48 hours the swelling decreased and the patient was removed from the ICU. The dosage of methylprednisone was decreased to 40 mg q6h and the patient was discharged the following day.

Conclusions:

The pathogenesis of angiotensin-converting enzyme (ACE) inhibitor-induced angioedema is not fully understood. This unique idiosyncratic adverse drug reaction may occur even though the medication has been tolerated for months or years. The symptoms may regress quickly while the patient is still taking the medication, resulting in no diagnosis, or the symptoms may progress rapidly despite aggressive medical intervention. The rapidly expanding market of these agents along with the expected availability of generic captopril in 1995 may increase overall prescriptions written for ACE inhibitors in the US, potentially increasing the number of cases of angioedema. This patient was diagnosed quickly and resulted in a positive outcome. Physicians and other healthcare providers should be aware of the symptoms of ACE inhibitor-induced angioedema and make their patients aware as well.
Role of Nonsteroidal Antiinflammatory Drugs in the Differential Diagnosis of Neoplastic Fevers versus Fevers of Infectious Etiology
Authors: Rabon Parrish G , Murray Kim M
Published: July 2017

Objective:

To determine the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the differential diagnosis of neoplastic fevers versus fevers of infectious etiology and to recommend a therapeutic regimen as well as a suggested treatment duration of NSAID therapy to aid in this diagnosis.

Data Sources:

The English-language literature was searched using MEDLINE, Index Medicus, and bibliographic reviews of relevant textbooks and review articles.

Conclusions:

NSAIDs have induced dramatic antipyretic effects when administered to patients with cancer whose fevers are particularly disabling and often a major contributor to patient morbidity and mortality. When a fever persists after infection has been ruled out, an NSAID test may be of diagnostic value for a neoplastic fever. Naproxen, indomethacin, and diclofenac all have been studied and demonstrated efficacy. A reduction or cessation of a neoplastic fever can be expected within 24 hours after initiation of NSAID therapy. However, NSAID therapy should be continued for three days before cessation of therapy or a change to another NSAID is considered.
Efficacy of Intranasal Apomorphine in Parkinson's Disease
Authors: Duarte Jacinto , Ruiz Maria Dolores , Mataix Angel L , Sempere Angel P , García Francisco M , Coria Francisco , Jose Maria Angeles San , Clavería Luis Erick
Published: July 2017

Objective:

To suggest that intranasal delivery may offer an effective alternative to subcutaneous injection of apomorphine.

Methods:

Four patients (3 men, 1 woman) with idiopathic Parkinson's disease, with disabling “on-off” fluctuations in motor performance, despite optimal adjustment in the levodopa regimen and use of dopamine agonists, were included in this study. Their mean age was 61.5 years (range 58–65) and the mean duration of the disease was 13.5 years (range 5–18). The mean duration of levodopa treatment was 12.2 years (range 5–16). Disabling fluctuations had been present in these patients for more than 1 year. The Hoehn and Yahr stage was III-IV during the off periods. All four patients had dyskinesia when receiving the peak dose. Levodopa and dopamine agonist medications were unchanged for 1 month before the study. All four patients had already received intermittent subcutaneous apomorphine injections for a mean of 12.25 months (range 7–16). Apomorphine solution 10 mg/mL was administered with the use of a metered-dose nebulizer that delivered 1 mg of solution with each puff.

Results:

All patients showed a clear clinical response, with a mean reduction in daily off period of 94.5% with respect to the basal off period. No loss of therapeutic effect or increase in dyskinesia was observed compared with subcutaneous apomorphine. The speed, quality, and duration of response were comparable with that found with injection of apomorphine. One patient showed a slight vestibulitis, but it did not interfere with the efficacy of apomorphine.

Conclusions:

Intranasal apomorphine is a comfortable and easy alternative to subcutaneous apomorphine in the treatment of off phases in patients with Parkinson's disease and severe refractory motor fluctuations.
Phenytoin in the Treatment of Epidermolysis Bullosa
Authors: Moshfeghi Mersedeh , Contractor Ghazala M
Published: July 2017

Objective:

To review the efficacy of phenytoin in the treatment of epidermolysis bullosa (EB).

Data Sources:

English-language clinical study reports, abstracts, case reports, and review articles pertaining to the use of phenytoin in the treatment of EB (MEDLINE search, January 1973-August 1996).

Data Extraction:

Clinical study and case reports evaluating the effect of phenytoin in the treatment of EB were reviewed, and the methodology, results, and conclusions of the studies were evaluated. Because of the limited number of randomized, controlled study reports, all available case reports were reviewed, and information we considered pertinent was synthesized.

Data Synthesis:

Results of studies of EB suggest that the blister fluid and fibroblasts in patients with this disease produce an increased amount of collagenase, which is thought to induce blistering. Phenytoin inhibits collagenase synthesis and/or secretion and, therefore, is used to treat patients with EB. Data regarding the use of phenytoin in patients with EB, especially those with recessive dystrophic EB, revealed that phenytoin may reduce the number of blisters in these patients. Dosage recommendations and monitoring parameters are also discussed.

Conclusions:

More randomized, controlled trials are needed to determine the true efficacy of phenytoin in the treatment of EB. Although the only available report of a randomized, controlled trial reported a lack of phenytoin efficacy in patients with EB, it does not rule out the possibility of success in selected patients.