bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Organic-Contaminated Industrial Wastes Using Cement-Based Stabilization/Solidification— Ii. Microstructural Analysis of the Organophilic Clay as a Pre-Solidification Adsorbent
Authors: Montgomery D.M. , Sollars C.J. , Perry R. , Tarling S.E. , Barnes P. , Henderson E.
Published: October 2007

In the preceding paper detailed microstructural studies were presented of some fundamental aspects of the interactions of two organic compounds on a cement matrix. Organophilic clays are now attracting increasing attention as potential pre-solidification adsorbents to reduce adverse organic-cement interactions in solidification/stabilization (S/S) systems. This paper presents extensive microstructural studies of interactions between an organophilic clay, containing adsorbed organic wastes, and a cement matrix. Such interactions must be as fully understood as possible if the long-term integrity of the organophilic clay/cement mixes, in whatever formulation, is to be assured in S/S applications.

A range of mixes was made up with the objective of characterizing the interaction of the organophilic clay with phenolic compounds and cement using microstructural methods. This approach was adopted in order to enable essential comparisons to be made between clay-containing and clay-free S/S mixes, using the same organics in both cases. Microstructural studies of organic-free cement/clay mixes showed that the presence of the clay caused an inhibition of the initial ettringite formation, up to seven days, but once ettringite had begun to form it increased to 140% of that in OPC paste at 28 days. Scanning electron microscopy (SEM) micrographs showed that the whole fracture surface was covered with a mat of needle shaped crystals approximately 1 μm in length. These results indicated that the incorporation of clay into the cement matrix may cause the strength reduction observed in macrostructural studies by altering the cement hydration reaction. Microstructural analysis of the solidified (post-adsorption) 3-chlorophenol showed that its detrimental effects on the cement hydration reaction were minimized, provided that the maximum adsorption capacity of the clay was not exceeded.
Effects of Volatile Organic Compounds On Clay Landfill Liner Performance
Authors: Edil T.B. , Berthouex P.M. , Park J.K. , Hargett D.L. , Sandstrom L. , Zelmanowitz S.
Published: October 2007

Clay borrow materials intended for use in a clay liner system were found to be contaminated by low concentrations of volatile organic chemicals (VOCs). The suspected source of contaminants was a nearby Superfund site where similar compounds were found in soil and groundwater. Based on these observations, questions were raised regarding the potential effects of VOCs on the performance of the clay materials as a landfill liner.

Laboratory experiments were conducted to evaluate the effects of three levels of soil precontamination and two types of permeants. Atterberg tests showed that the precontaminations (acetone and m-xylene) and the simulated leachate (methylene chloride, trichloroethylene, and toluene), at the concentrations used, did not impact clay-pore fluid interaction. Sedimentation tests showed that the impact of methylene chloride, trichloroethylene, and toluene on sediment volume and rate of settlement was not detectable up to the maximum concentration level of 100 ppm for each chemical.

From the permeation tests, acetone in the precontaminated samples was generally flushed out within three pore volumes but m-xylene was not detected (above the detection limit of 0.01 mg 1-1) in the permeant effluent. The stabilized permeabilities of the specimens ranged from 0.2 × 10-7 to 3.0 × 10-7 cms-1. It was found that precontamination of the clay at the levels studied did not affect organic chemical leachate transport/adsorption discernibly when compared with clean clay, and no measurable retardation or adsorption of VOCs in clay liners occurred in either clean clay or precontaminated clay.
A Computer Simulation Model for Fleet Sizing for the Marine Division of the New York City Department of Sanitation
Authors: Larson Richard C. , Minkoff Alan S. , Gregory Paul
Published: October 2007

The Marine Division of the New York City Department of Sanitation (DOS) operates a fleet of tugboats and barges for the transport of refuse from New York City to Fresh Kills Landfill on Staten Island. In the early 1980s, DOS was faced with a situation whereby many of its barges were aged and decrepit, yet workload was scheduled to increase as another major landfill was shut down. With major barge investment decisions on the horizon, DOS commissioned the development of the Barge Operations Systems Simulator (BOSS), for assistance in the task of fleet sizing. This paper reports on the development and use of the BOSS model.
A Field Trial of a Bentonite Landfill Liner
Authors: Cowland J.W. , Leung B.N.
Published: October 2007

Field and laboratory trials were carried out for a bentonite amended weathered granite landfill liner. The trials were undertaken to gain experience in the installation method, and to establish the appropriate mixing techniques and mix design. It was established that a bentonite-amended weathered granite liner could be constructed on steep slopes. This paper presents the results of the trials, which included both field and laboratory permeability testing. It was found that the success of a soil bentonite liner is critically dependent on the mixture having the right moisture content at the time of compaction.
The Space Exploration Initiative: a Challenge To Advanced Life Support Technologies: Keynote Presentation
Authors: Mendell Wendell W.
Published: October 2007

President Bush has enunciated an unparalleled, open-ended commitment to human exploration of space called the Space Exploration Initiative (SEI). At the heart of the SEI is permanent human presence beyond Earth orbit, which implies a new emphasis on life science research and life support system technology. Proposed bioregenerative systems for planetary surface bases will require carefully designed waste processing elements whose development will lead to streamlined and efficient systems for applications on Earth.
Selection Criteria for Waste Management Processes in Manned Space Missions
Authors: Doll Susan , Cothran Brad , McGhee Jerry
Published: October 2007

Management of waste produced during manned space exploration missions will be an important function of advanced life support systems. Waste materials can be thrown away or recovered for reuse. The first approach relies totally on external supplies to replace depleted resources while the second approach regenerates resources internally. The selection of appropriate waste management processes will be based upon criteria which include mission and hardware characteristics as well as overall system considerations. Mission characteristics discussed include destination, duration, crew size, operating environment, and transportation costs. Hardware characteristics include power, mass and volume requirements as well as suitability for a given task. Overall system considerations are essential to assure optimization for the entire mission rather than for an individual system. For example, a waste management system designed for a short trip to the Moon will probably not be the best one for an extended mission to Mars. The purpose of this paper is to develop a methodology to identify and compare viable waste management options for selection of an appropriate waste management system.
Collection and Management of Fecal Wastes for Space Missions
Authors: Rethke Donald W. , Steele John W.
Published: October 2007

An improved type of human waste collection subsystem has been developed for Space Station Freedom which is designed to meet the challenges of zero gravity collection and system performance. Fecal collection is followed by passive storage for relatively short duration missions. The benefits of utilizing components in solid wastes as part of a partial or completely closed Environmental Control and Life Support System (ECLSS) become more apparent as the duration of the mission increases. The purpose of this review is to summarize the development issues associated with the current waste management subsystem for Space Station Freedom. Also reviewed are current ideas associated with the evolutionary development of this waste management subsystem for longer duration missions.
Collection, Compaction and Storage of Solid Waste for Space Missions
Authors: Agrella Martin L. , Smith Malcolm C.
Published: October 2007

Efficient trash collection and volume reduction becomes very important during extended, manned space flight missions because of the high rate of crew member generated trash and the limited volume available to store this trash. Trash management in manned space flight vehicles requires that the following considerations be addressed: definition of the trash model including quantities/rates of generation and the physico-chemical characteristics of the trash; methods of collection and temporary stowage prior to treatment or processing; the method of treatment/processing to affect biochemical stabilization and volume reduction; and storage of treated/ processed trash prior to final disposition. This paper discusses trash management design approaches with focus on trash collection, compaction and storage. This paper also discusses the trash compactor design currently being developed for the Space Station Freedom program.
Conventional and Innovative Land-Based Technologies for Waste Combustion
Authors: Oberacker Donald A.
Published: October 2007

This paper is an overview of various land-based technologies for safely treating waste materials. Covered are both the older, proven devices, such as conventional incinerators, as well as some of the new or novel technologies which thus far have found limited application. It is hoped that this paper can provide some degree of guidance to NASA in their search for appropriate systems for waste treatment, disposal, and/or recycling in space mission programs.
Potential Useful Products From Solid Wastes
Authors: Golueke Clarence G. , Diaz L.F.
Published: October 2007

Wastes have been aptly defined as "items, i.e. resources, that have been discarded because their possessors no longer have an apparent use for them". Accordingly, "wastes" have a significance only in relation to the items and those who have discarded them. The discarded items now are resources awaiting reclamation. Reclamation usually involves either salvage or conversion—or in modern terminology, "reuse" or "recycling". Reclamation for reuse consists in refurbishing or other upgrading without significantly altering original form and composition. Examples of wastes amenable to reuse are containers (bottles, etc.), cartons and repairable tires. With "recycling" (i.e. conservation), the discarded items are processed such that they become raw material, i.e. resources in the manufacture of "new" products. The variety of processes is wide, ranging from simply physical (grinding) through thermal (melting, gasification, combustion), to biological (composting, biogasification, hydrolysis, microbial protein production). In the paper, reuse and recycling (conversion) are evaluated in terms of advantages and disadvantages (limitations) and their respective technologies are described and discussed in detail.
Plants for Water Recycling, Oxygen Regeneration and Food Production
Authors: Bubenheim David L.
Published: October 2007

During long-duration space missions that require recycling and regeneration of life support materials the major human wastes to be converted to usable forms are CO2, hygiene water, urine and feces. A Controlled Ecological Life Support System (CELSS) relies on the air revitalization, water purification and food production capabilities of higher plants to rejuvenate human wastes and replenish the life support materials. The key processes in such a system are photosynthesis, whereby green plants utilize light energy to produce food and oxygen while removing CO2 from the atmosphere, and transpiration, the evaporation of water from the plant. CELSS research has emphasized the food production capacity and efforts to minimize the area/volume of higher plants required to satisfy all human life support needs. Plants are a dynamic system capable of being manipulated to favour the supply of individual products as desired. The size and energy required for a CELSS that provides virtually all human needs are determined by the food production capacity. Growing conditions maximizing food production do not maximize transpiration of water; conditions favoring transpiration and scaling to recycle only water significantly reduces the area, volume, and energy inputs per person. Likewise, system size can be adjusted to satisfy the air regeneration needs. Requirements of a waste management system supplying inputs to maintain maximum plant productivity are clear. The ability of plants to play an active role in waste processing and the consequence in terms of degraded plant performance are not well characterized. Plant-based life support systems represent the only potential for self sufficiency and food production in an extra-terrestrial habitat.
Immobilized Microbe Bioreactors for Waste Water Treatment
Authors: Portier Ralph J. , Miller Gary P.
Published: October 2007

The application of adapted microbial populations immobilized on a porous diatomaceous earth carrier to pre-treat and reduce toxic concentration of volatile organics, pesticides, petroleum aliphatics and aromatics has been demonstrated for several industrial sites. In the pre-treatment of industrial effluents and contaminated ground-waters, these bioreactors have been used to optimize and reduce the cost of conventional treatment systems, i.e. steam stripping, carbon adsorption and traditional biotreatment. Additionally, these systems have been employed as seeding devices for larger biotreatment systems. The cost effective utilization of an immobilized microbe reactor system for water supply regeneration in a microgravity environment is presented. The feasibility of using immobilized biomass reactors as an effluent treatment technology for the biotransformation and biodegradation of phenols, chlorinated halocarbons, residual oils and lubricants was evaluated. Primary biotransformation tests of two benchmark toxicants, phenol and ethylene dichloride at concentrations expected in life support effluents were conducted. Biocatalyst supports were evaluated for colonization potential, surface and structural integrity, and performance in continuous flow bioreactors. The implementation of such approaches in space will be outlined and specific areas for interfacing with other non-biological treatment approaches will be considered for advanced life support, tertiary waste water biotreatment.
Long-Term Planning for Solid Waste Management in India
Authors: Shekdar A.V. , Krishnaswamy K.N. , Tikekar V.G. , Bhide A.D.
Published: October 2007

Most of the existing models of solid waste management deal with a single point of time and are based on the fixed charge problem. In developing countries the fixed charge problem approach is not adequate in the modelling of solid waste management systems. Moreover, in fast growing cities the problem of locating disposal sites and allocating collection areas to them becomes difficult in the long-term. This paper deals with the application of a transportation model designed to minimise solid waste handling costs over several developmental phases of an urban area. The model is applied to an actual case to demonstrate its usefulness for long-range planning in cities.
Factors Related To the Diversity and Distribution of Soil Fauna On Gin Drinkers' Bay Landfill, Hong Kong
Authors: Wong M.H. , Cheung K.C. , Lan C.Y.
Published: October 2007

The major potential problems from a landfill are biogas and leachate generated from the wastes deposited. These factors can also exert harmful effects on the growth of vegetation and influence the diversity and distribution of soil animals, either directly or indirectly. This paper describes investigations undertaken at the completed Gin Drinkers' Bay landfill, Hong Kong. The absence of plant cover at the site limited the occurrence of some common soil animals such has Diplopoda, Hemiptera, Isopoda and Isoptera. This was possibly due to the shortage of plants as shelter and the lack of organic matter as food. One area (site H), with a high level of landfill gas in the soil zone, had a lower diversity of soil animals than another area (site L) with a lower level of landfill gas. Some edaphic factors such as moisture content and concentrations of K, Na and Mg in the "contaminated" site H may also have resulted in lower numbers of species and individuals.
Mineralization in a Calcareous Soil of a Sewage Sludge Composted With Different Organic Residues
Authors: Garcia C. , Hernandez T. , Costa F.
Published: October 2007

Three sewage sludge composts were obtained from mixtures of an aerobic sludge (AS) and three organic wastes differing widely in chemical composition: an extremely biodegradable waste (municipal solid waste, MSW), a plant residue (grape debris) and a residue with a carbon fraction not easily mineralizable (peat residue). The following mixtures were made, the proportions referring to their total organic carbon content: AS-MSW 1/1, AS-GRAPE 3/1 and AS-PEAT 1/1. These mixtures were composted over 3 months in the open air with periodical turning, and were left to mature afterwards for 4 months. Uncomposted mixtures and composted mixtures, before and after maturation, were incubated for 38 days, under laboratory conditions, with a calcareous soil and the CO2 emission of the samples periodically measured.

Uncomposted mixtures emitted much greater quantities of carbon than those composted, whether before or after maturation period. Both at the beginning and at the end of composting, differences were observed between the total amount of carbon emitted by the mixture containing peat waste and the others. However, the quantities of carbon emitted from the three mixtures tended to even out in mature composts, reaching a maximum of 600 mg carbon per 100 g total organic carbon. This shows that, although the mineralization of carbon depends on the nature of the organic waste mixed with the sewage sludge, it tends to even out when the mixtures have undergone composting.
Interaction of a Cationic N-(2-hydroxypropyl)methacrylamide Copolymer with Rat Visceral Yolk Sacs Cultured in vitro and Rat Liver in vivo
Authors: Mccormick L. Anne , Seymour Leonard C.W. , Duncan Ruth , Kopecek Jindřich
Published: October 2007

N-(2-Hydroxypropyl)methacrylamide (HPMA) copolymers and polycations, such as poly-L-lysine, have been proposed as potential drug delivery systems. HPMA copolymers were synthesised to contain a low percentage of tyrosinamide residues facilitating their radioiodination, and in one case also containing a cationic group. The effect of the cationic residue on the association of copolymer with rat visceral yolk sacs incubated in vitro was studied. Cationic HPMA copolymer was found to associate progressively with the tissue over a five hour incubation period. Inhibitor studies (low temperature or addition of 2,4-dinitrophenol (50 μg/ml) indicated that this association was not primarily due to pinocytic capture of polymer, but due to adsorption onto the cell surface. Addition of non-radiolabelled cationic copolymer to the incubation medium did not in itself affect the rate of fluid-phase pinocytosis in yolk sac cells. Release of previously accumulated cationic copolymer from the tissue was shown to be rapid and consistent with desorption from the cell surface. Following intravenous administration to rats, the clearance of cationic copolymer from the bloodstream was rapid, the majority of radioactivity being recovered in the liver (after 30 min). Subcellular fractionation of liver showed that the cationic HPMA copolymer bound initially to the liver cell membrane. Over a 60 minute period, approximately 58% of radiolabelled polymer was transferred slowly to the secondary lysosomes.
The Activity of Complement in the Presence of N-(2-hydroxypropyl)methacrylamide Copolymers
Authors: Šimečková J. , Ríhová B. , Plocová D. , Kopecek J.
Published: October 2007

This study indicates that N-(2-hydroxypropyl)methacrylamide homopolymers and copolymers containing oligopeptide sequences terminated in carboxylic acid groups, amine groups, aromatic units, or puromycin have no prominent effect on the porcine complement system in vitro. Inhibition of both pathways of the complement system occurred at concentrations highly exceeding the dose suitable for therapeutic purposes.
Review: Advances in Intraperitoneal (Intracavitary) Administration of Synthetic Polymers for Immunotherapy and Chemotherapy
Authors: Regelson William
Published: October 2007

Intraperitoneal (IP) catheters linked to subcutaneous portals have made routine intracavitary chemotherapy or immunotherapy safe and convenient. The IP route is anatomically appropriate for adjuvant or palliative treatment of intracavitary disease. IP chemotherapy has been successfully applied to ovarian, mesothelial, and gastrointestinal tumors.

Data shows that IP divinyl ether/maleic anhydride copolymer. MVE-2 (MW 15,000), has distinct localizing and toxicologic differences from that given intravenously (IV). When MVE-2 is given IV renal injury is observed; this is not seen on IP administration. The highest IP concentrations are found in mediastinal and mesenteric nodes, thymus and testis while the highest IV MVE-2 accumulation is found in the liver, spleen, adrenal, and kidney.

The IP route for treatment of tumors allows for high local tumoricidal drug concentrations or for regionalized immunostimulation with activating polymers or leukokines. The IP space can provide an antitumor, and antiviral immunizing site and/or a source of activated antitumor peritoneal exudate cells. The use of IP chemotherapy readily permits systemic neutralization of drug toxicity and can provide high portal venous concentrations of drug for the treatment of early liver metastasis.

This review speaks to the convenience and safety of the IP intracavitary route which provides a new option for the clinical utilization of polymers where regionalized abdominal effects and improved therapeutic index are warranted. The biologic application of IP polymers requires polymer distribution and kinetic studies which will provide unique tissue concentrations for application to immunization, cancer treatment and other diseases.
Respiratory Effects of Short-Term, High-Intensity Toxic Inhalations: Smoke, Gases, and Fumes
Authors: Wald Peter H. , Balmes John R.
Published: October 2007

Respiratory insufficiency resulting from inhalation of hot air, smoke, or toxic gas is a common cause of death in fire victims. Toxic gas inhalation in settings other than fires is a less common but still important cause of death and disability. Pulmonary inhalation injury and systemic intoxication from exposure to a variety of agents are discussed with regard to their pathogenesis, pathophysi ology, diagnosis, and treatment. Upper airway obstruc tion and noncardiogenic pulmonary edema are the life- threatening respiratory complications in the immediate postinhalation period. Carbon monoxide and hydrogen cyanide intoxication are frequently associated with in halation injury in fire victims. Early recognition and treatment of inhalation injury and systemic intoxication in victims of fires and industrial and environmental acci dents could well result in improved survival.
Bacterial Sepsis in the Newborn Infant: Developmental Deficiencies in Neutrophils and the Role of Neutrophil Transfusion
Authors: Harper Thomas E. , Christensen Robert D.
Published: October 2007

Bacterial sepsis is an important cause of morbidity and mortality in newborns. Group B streptococci and Es cherichia coli are the primary causative organisms. New and theoretically more effective antibiotics have not im proved survival. Because the neonate has defects in the immune response, new forms of therapy may be able to improve outcome by correcting or circumventing those deficiencies. The neutrophil has a substantial role in antibacterial defense, yet neonatal neutrophil function is limited by impaired chemotaxis, phagocytosis, and in tracellular killing. The supply of neonatal neutrophils is restricted by a small neutrophil reserve, a delay in mobilization of neutrophils from the bone marrow re serve after bacterial invasion, a small granulocytopoietic progenitor cell reserve, and a limited ability to acceler ate proliferation of progenitor cells during bacterial in fection. Recent studies of neutrophil transfusions in in fected neonates suggest a beneficial effect at least in certain situations. Exchange transfusion with fresh whole blood may be an alternative to transfusion with neutro phils obtained by apheresis. The ultimate role of neutro phil transfusions as an adjunct therapy for neonatal sep sis remains to be determined.
Emerging Practice Arenas for the Consultant Pharmacist
Authors: Maine Lucinda L.
Published: October 2007

The growth of the aged population and changing characteristics of the elderly and their caregivers require that alternatives to institutional long-term care be developed. The need for consultant pharmacy services can be hypothesized on the basis that a considerable number of these individuals have similar levels of disability as nursing home residents. The experience of consultant pharmacists in noninstitutional environments is reviewed in this article. These environments include health maintenance organizations, home health care agencies, and residential care facilities. Barriers to providing nontraditional consulting services include (1) a lack of a regulatory mandate, (2) lack of formal reimbursement mechanisms, (3) lack of an expectation for services on the part of other providers and administrators, and (4) lack of an assertive marketing posture on the part of pharmacists. Strategies for overcoming these obstacles are discussed. Increased reliance on noninstitutional settings for the long-term care of older citizens will increase the opportunities for consulting services by pharmacists who are willing to demonstrate to other providers that inappropriate drug use in these settings results in increased cost and decreased quality of care for clients.
Nutritional Assessment and Support in Long-term Care Facilities
Authors: Barber Jacqueline R.
Published: October 2007

In recent years, malnutrition has become recognized as a widespread phenomenon with significant potential for complicating the course of medical treatment and compromising quality of life for hospitalized patients, many of whom are elderly. Added to this has been a heightened awareness of the needs of the institutionalized geriatric segment of our population. This group is now acknowledged as being at significant risk for nutritionally related morbidity as a result of advanced age, chronic or underlying disease, multiple drug therapy, and/or a host of social, psychological, and economic factors. The questions arise of how to identify those at risk, define the extent of their nutritional problems, and then how to best address their needs in a safe and effective manner. Recent technological advances in parenteral and enteral nutrition coupled with increasing clinical experience have greatly improved the care of the malnourished patient in the hospital, and have fostered the development of programs for outpatient nutritional management as well. Along with more sophisticated methods of providing nutritional care, various strategies are evolving for coordination and administration of nutritional assessment and support in the nation's long-term care facilities based on experience with hospitalized patients and home nutritional support programs. Clearly, there is a need for research and further attention to providing such services to these individuals. Pharmacists are now finding great professional opportunity in responding to the demand for specialized nutritional support services in this rapidly growing elderly segment of our population.
Research in Long-term Care Facilities
Authors: Ramsey Ruthanne R. , Lutz Lawrence J.
Published: October 2007

Clinical research in geriatrics, to date, has focused on the ambulatory and acutely ill patient populations. However, the unique host, disease, and environmental factors common to the nursing home resident and facility underline the need to study drug use and response in the long-term care facility. Five specific areas require investigation: efficacy, safety, dosages, utilization, and cost. To adequately study these topics, interdisciplinary research teams may use methodologies from various backgrounds, including the biologic, agricultural, epidemiologic, economic, and ethnographic research traditions. Even with the numerous methodologies available, significant procedural and design issues confront the development and performance of long-term care research. While procedural problems usually involve legal and administrative issues, methodologic concerns often stem from the need to deal with multiple confounding variables or the limitations of available research tools and clinical data bases. Continued improvement in the existing quality-of-life and functional assessment instruments as well as the development of computerized nursing home data bases will enhance clinical research in the long-term care facility.
Drug Disposition in the Pediatric Patient
Authors: Young Sharon L.
Published: October 2007

The pediatric patient is a unique individual who undergoes continual physiologic change from the time of conception through adolescence. The pharmacokinetics of therapeutic agents are influenced by physiologic changes that ultimately affect drug therapy. The gastric absorption of many therapeutic agents is altered by changes in gastric pH, gastric emptying, intestinal motility, biliary function, pancreatic function, and regional blood flow. Intramuscular absorption is erratic and unpredictable because of reduced skeletal muscle mass, alterations in regional blood flow, and physical activity. Percutaneous absorption is increased in the neonate due to increased water content and decreased thickness of the stratum corneum. The distribution of many therapeutic agents is increased in the neonate and infant because of an increase in extracellular fluid and total body water, alterations in tissue binding, and decreased plasma protein binding. The metabolic capacity and elimination processes of the newborn are greatly reduced compared to the adult; hepatic function is approximately one-half that of adults and renal elimination is similarly reduced. Hepatic function in the infant and young child may actually exceed that in the adult due to the increase in hepatic metabolic surface area to body weight ratio. Renal function matures relatively quickly in the neonate and approaches adult drug renal elimination rates within the first year of life. There is a lack of clinical research that defines therapeutic guidelines in the pediatric patient for specific drugs. However, an understanding of these physiologic changes that take place during growth and development in the pediatric patient will facilitate optimal drug therapy in this patient population. Following the initiation of drug therapy, the continued physiologic changes taking place in the pediatric patient necessitate continual therapeutic drug monitoring and periodic dosage adjustments. These special considerations challenge and enhance the responsibility of the pharmacist as a key member in assuming safe and effective pediatric drug therapy.
Pediatric Immunizations: A Review
Authors: O'Brien Timothy J.
Published: October 2007

Since Edward Jenner discovered that injecting cowpox virus into humans could prevent smallpox, the science of immunology has produced many vaccines that have virtually eradicated some of the worst childhood diseases known to mankind. Along with this great benefit, some vaccines carry with them potentially serious side effects. This review considers the mechanisms of immunology and how these are taken advantage of in vaccine production. The pharmacist is then acquainted with each of the vaccines used in childhood: measles, mumps, rubella (MMR); diphtheria, tetanus toxoids, and pertussis (DTP); oral polio vaccine (OPV); inactivated polio vaccine (IPV); and Hemophilus influenza type b vaccine (HIB). A review of each respective disease entity is considered along with each vaccines's method of production, immunization schedule, and adverse reactions. Some of the more controversial issues of vaccination are considered such as the use of live attenuated vaccines in human immunodeficiency virus (HIV) positive children and the inadvertent use of rubella vaccine in pregnant women. This report capitalizes on the most recent recommendations of the Immunization Practices Advisory Committee in order to provide the pharmacist with the most current information in the field of vaccine immunology today.
Therapy of Childhood Asthma
Authors: O'Hara William J. , Weidel Regina M.
Published: October 2007

The pathophysiology of asthma is briefly reviewed and the primary modalities of drug therapy are described. Symptoms of asthma are the result of bronchospasm, increased mucous secretion, and inflammation of the airways. An acute attack is a medical emergency that necessitates prompt treatment. Acute exacerbations are primarily treated with β-2 agonists by inhalation, with the addition of methylprednisolone and aminophylline as needed. The mainstay of therapy in chronic asthma is prophylaxis with theophylline, with cromolyn sodium as an alternative in certain patients. The addition of β-2 agonists, corticosteroids, or anticholinergics may be necessary, depending upon the severity and frequency of the attacks. The mechanisms of action of the standard therapeutic agents are reviewed, along with the dosages, side effects, and major drug interactions. Newer agents under investigation are also described, some of which represent totally new pharmacologic approaches to the therapy of asthma, such as H-1 receptor blockers, platelet activating factor (PAF) antagonists, and calcium channel blockers.
Rapid Therapeutic and Biotechnological Advances: Effects on Practice
Authors: Pruemer Jane M.
Published: October 2007

As practices have rapidly evolved over the past 20 years into various areas of specialization, pharmacy managers have recognized different needs of specialists. Accelerated development of antineoplastic and biotechnological agents has propelled oncology practitioners and educators to keep with the pace of these developments. The rapid growth of biotechnology will play the most important role in shaping the direction of oncology pharmacy in the next decade. The development of recombinant growth factors, such as erythropoietin and granulocyte-macrophage colony-stimulating factor as well as interleukins, interferons, and monoclonal antibodies, heralds a new era in the treatment and diagnosis of cancers. Pharmacy managers can assist this process by supporting clinicians and educators with excellent distributive services, readily accessible drug information resources, and the capability of attending continuing educational programs in the areas of biotechnology and new drug delivery systems.
Understanding and Using Professional Peer-Assistance Programs
Authors: Hasty John
Published: October 2007

The idea of using concerned caring peers to intervene on behalf of another peer who is suffering from the disease of chemical dependency is a rather new concept in our society. However, the idea has produced great success and today we find that most professional societies sponsor a peer-assistance program. Peer programs are easy to access and provide an array of services. Some of the services extend to the entire professional population. Such things as continuing education credit and monitoring of recovering pharmacists for an employer can benefit all members of the profession. Because peer programs work very closely with State Boards of Pharmacy, advocacy can be provided for the recovering pharmacist. A person who feels the need to report a suspected impairment can feel comfortable that the peer committee and the professional licensing board will handle the problem in a fair and confidential manner. Colleagues, coworkers, spouses, or any concerned person should feel good about using the services of a peer-assistance committee. Use of these services can make the difference in saving the professional career or possibly the life of a peer or loved one.
Medication Refill Clinics: The Veterans Administration Medical Center Experience
Authors: Cram David Lee , Maesner Ann T. , Witmore Douglas M.
Published: October 2007

Medication refill clinics have been operating for about two decades. These clinics provide cost-effective and high-quality pharmaceutical care to patients who require refills on their medications. The following article describes one Veterans Affairs Medical Center's experience with a medication refill clinic. Guidelines for setting up a refill clinic are presented, including clinic development and justification, training of the practitioner, policies and procedures, and quality assurance management. Benefits of the clinic also will be discussed.
Family Medicine Clinical Pharmacy: The South Carolina Experience
Authors: Schneider Eric F. , Weart C. Wayne , Stier Carson Deborah
Published: October 2007

Since its inception over 25 years ago, clinical pharmacy has extended into virtually every subspecialty of medicine, including Family Medicine. Family Medicine philosophically supports a team approach to health care that has welcomed the pharmacist as an active member for over 15 years. The association between Family Medicine physicians and pharmacists has evolved into one that embodies the concept of pharmaceutical care. This article provides a historical perspective of the pioneers in Family Medicine clinical pharmacy in South Carolina, reviews the goals and visions of the early pharmacists, and reevaluates this information as it applies to clinical pharmacy today.
Pharmacokinetics Laboratory and Consultation Service for Ambulatory Patients
Authors: Ellison Mark J. , Cummings Doyle M.
Published: October 2007

When implementing clinical pharmacokinetics consultation services for ambulatory patients, one should strongly consider developing an outpatient pharmacokinetics laboratory. Published literature clearly documents the benefits of clinical pharmacokinetics services. In addition, there are educational, financial, and research advantages to creating an outpatient pharmacokinetics laboratory. One should demonstrate the need for the service; determine the scope of services; design patient and specimen work flow; decide what personnel, space, and equipment are needed; and justify costs and revenue. Recent federal legislation, such as the Clinical Laboratory Improvements Amendments and the Occupational Exposure to Hazardous Chemical in Laboratories Act (1988), will have a significant positive impact on an outpatient pharmacokinetics laboratory.
The Role of the Pharmacist in the Care of the Ambulatory Diabetic Patient
Authors: Kirchain William R. , Knowlton Calvin
Published: October 2007

The management of diabetes often includes significant changes in diet, exercise patterns, social activities, and medication-taking behavior. Many of these changes are a burden on patients and their families. The best approach to the management of a person with diabetes is an approach that empowers the patient. Pharmacists often are in the best position within the health care team to facilitate patient empowerment. A few pharmacists have taken advantage of this niche to open a variety of practices serving the needs of people with diabetes. At the Philadelphia, PA, Veterans Administration Medical Center (VAMC), a Pharmacy Diabetes Clinic was established with diabetes-related research as its primary goal. Educational and skill development services also are offered to patients. The same pharmacist involved in the Philadelphia VAMC Pharmacy Diabetes Clinic has recently begun the process of setting up an adjunct pharmacy service for people with diabetes within an existing community practice. Rough comparisons between these two practice settings are discussed, including the differences in available data, clinic objectives, and administrative aspects.
The Managed Health Care Market
Authors: Hemberger William A.
Published: October 2007

Health care delivery and benefits in the United States are changing. This article provides a basic description of the present-day components, managed care constructs, and impact of medical/hospital program/ benefit designs on pharmacy programs.
Comprehensive Drug Utilization Review: Adding Physician Outreach to Concurrent and Retrospective Drug Utilization Review
Authors: Kellenberger Thomas A.
Published: October 2007

Communication about drug selection and use between physicians and pharmacists has changed in the last two decades. The enhanced clinical education offered to pharmacists and the recognition by many physicians that keeping up with advances in drug therapy is exceedingly difficult and time consuming has facilitated the change. Accordingly, hospitals and long-term care facilities have formalized the clinical role of the pharmacist in drug selection, use, and/or monitoring through the use of drug utilization review (DUR) programs, specifically called drug use evaluation (DUE) and drug regimen review (DRR), respectively, in these environments. A majority of drug therapy decisions, however, occur outside of these closed environments where the physician's drug information is often provided by representatives of the pharmaceutical manufacturers and where comprehensive DUR programs are in their infancy. As a source of information on drug products available from their company, sales representatives perform a valuable service, but their information, understandably, is focused on the advantages of their products. Making appropriate choices from alternative therapies that are more plentiful, complex and expensive than ever requires the physician to have access to current, scientifically valid, objective and unbiased information. Building on the value inherent in concurrent and retrospective DUR programs and on research conducted in the early 1980s, Medco Containment Services has developed a program that brings this type of prescribing information directly to physicians in their offices. Called the Optimal Therapeutics ProgramSM (OTPSM), Medco's program is fully operational in the Commonwealth of Massachusetts and is the vehicle for bringing clinically relevant, objective, and cost-effective prescribing information to physicians for application in the ambulatory care marketplace. This innovative program augments concurrent and retrospective DUR, delivering truly comprehensive DUR services. OTP also provides an opportunity for highly motivated and skilled pharmacists to shape their emerging role as drug information consultants.
The Pharmacological Treatment of Human Immunodeficiency Virus Infection
Authors: Wong Roberta J.
Published: October 2007

Treatment of human immunodeficiency virus (HIV) infection has only recently been possible with the discovery of the HIV life cycle and antiretroviral agents. Reverse transcriptase, a unique enzyme carried by retroviruses, allows viral RNA to be copied to DNA. The elucidation of the life cycle in 1984 and the discovery of zidovudine's effectiveness against HIV in 1985 has offered options for people with HIV infection. Zidovudine (Retrovir; Burroughs Wellcome; Research Triangle, NC), originally known as azidothymidine, is indicated in adult patients with symptomatic and asymptomatic HIV infection with CD4 cell counts less than 500. Doses of 200 mg every 4 hours for 1 month, then 100 mg every 4 hours are recommended. Zidovudine is also indicated for use in children older than 3 months with advance symptomatic HIV disease. A dose of 180 mg/M2 every 6 hours of zidovudine is recommended. Even at low doses, zidovudine is not without toxicity. Acute symptoms of headache or nausea may affect up to 50% of patients usually within the first 2 to 3 weeks of initiation. Other side effects that occur less frequently include fever (5% to 19%), insomnia (8%), diarrhea (12%), asthenia (20%), and myalgia (8%). Patients with late-stage disease are thought to develop resistant strains more quickly than patients with asymptomatic infection, often within a few months after zidovudine therapy begins. It has been estimated that up to 30% of patients with late-stage disease may show resistant strains after 1 year of continuous zidovudine therapy. The clinical significance of resistance has not been proven yet, because the appearance of strains resistant to zidovudine has not been clearly correlated with a worsening prognosis. Didanosine (formerly dideoxyinosine [ddI]) and zalcitabine (formerly dideoxycytidine [ddC]) are also reverse-transcriptase inhibitors and require triphosphorylation, similar to zidovudine. The purine analogs share a different adverse reaction profile, showing less bone marrow toxicity than zidovudine, a pyrimidine analog. Several other agents are under investigation. These include d4T, fluorothymidine, CD4, and interferon alfa. Combination therapy of reverse-transcriptase inhibitors and antiretroviral agents plus immune-stimulating agents may prove efficacious in the near future.
Overview of the Food and Drug Administration Procedures for Expediting the Development and Evaluation of Drugs for the Treatment of Acquired Immunodeficiency Syndrome and Other Life-Threatening Illnesses
Authors: Hunter James R. , Rosen David L. , DeChristoforo Robert
Published: October 2007

The acquired immunodeficiency syndrome (AIDS) epidemic has focused increased attention on new drug development and the Food and Drug Administration (FDA) evaluation process for durgs to treat patients with AIDS and other severely debilitating or life-threatening illnesses. To expedite the review of these experimental drugs and to make them available to patients earlier in the development process, the FDA has implemented new procedures and mechanisms. In the new drug regulations, the subpart E procedures commit the FDA to extensive and intensive participation in the initial stages of development of these drugs. Early consultation by the FDA with drug sponsors, more frequent meetings between the FDA and drug sponsors, larger and more extensive phase 1 and phase 2 trials, and postmarketing surveillance are some of the key features of these FDA procedures. The subpart E procedures reflect the philosophy that early involvement by the FDA in drug study design enhances the likelihood that the results from these studies will provide enough information to allow the FDA to more quickly assess the safety and efficacy of these drugs. Treatment Investigational New Drug Applications (INDs) increase the early availability of experimental drugs in the final stages of the FDA evaluation process, but before final approval. Both the parallel track proposal and the accelerated drug approval concept are additional mechanisms intended to increase the early availability of drugs for patients with AIDS.

This is a US government work. There are no restrictions on its use.
The lexical field of visual perception in The French Lieutenant's Woman by John Fowles
Authors: Faber Pamela , Wallhead Celia
Published: October 2007

In The French Lieutenant's Woman the lexical field of visual perception is strongly foregrounded. The appearance of so many significant vision words, both the superordinate terms and their hyponyms, is related to the creation of the characters and to the development of the narrative. This article sets out the lexical field of visual perception, its hierarchies, oppositions and metaphorical projections, both at the beginning and in the appendices, showing how this semantic domain is covered in the novel. We go on to suggest that this foregrounding has a literary purpose, and indicate five distinct functions. It can also be explained by the peculiar genesis of this novel as a visual image, attested to by Fowles himself. The novelist's use of visual perception terms throws light on how a postmodem writer of self-conscious fiction works through making choices inside and outside restricted fields.