bluuebunny/crossref_metadata_2025 huggingface dataset:
Jeffries Matusita-Spectral Angle Mapper (JM-SAM) spectral matching for species level mapping at Bhitarkanika, Muthupet and Pichavaram mangroves
Authors: Padma S. , Sanjeevi S.
Published: December 2014

Abstract. This paper proposes a novel hyperspectral matching algorithm by integrating the stochastic Jeffries-Matusita measure (JM) and the deterministic Spectral Angle Mapper (SAM), to accurately map the species and the associated landcover types of the mangroves of east coast of India using hyperspectral satellite images. The JM-SAM algorithm signifies the combination of a qualitative distance measure (JM) and a quantitative angle measure (SAM). The spectral capabilities of both the measures are orthogonally projected using the tangent and sine functions to result in the combined algorithm. The developed JM-SAM algorithm is implemented to discriminate the mangrove species and the landcover classes of Pichavaram (Tamil Nadu), Muthupet (Tamil Nadu) and Bhitarkanika (Odisha) mangrove forests along the Eastern Indian coast using the Hyperion image dat asets that contain 242 bands. The developed algorithm is extended in a supervised framework for accurate classification of the Hyperion image. The pixel-level matching performance of the developed algorithm is assessed by the Relative Spectral Discriminatory Probability (RSDPB) and Relative Spectral Discriminatory Entropy (RSDE) measures. From the values of RSDPB and RSDE, it is inferred that hybrid JM-SAM matching measure results in improved discriminability of the mangrove species and the associated landcover types than the individual SAM and JM algorithms. This performance is reflected in the classification accuracies of species and landcover map of Pichavaram mangrove ecosystem. Thus, the JM-SAM (TAN) matching algorithm yielded an accuracy better than SAM and JM measures at an average difference of 13.49 %, 7.21 % respectively, followed by JM-SAM (SIN) at 12.06%, 5.78% respectively. Similarly, in the case of Muthupet, JM-SAM (TAN) yielded an increased accuracy than SAM and JM measures at an average difference of 12.5 %, 9.72 % respectively, followed by JM-SAM (SIN) at 8.34 %, 5.55% respectively. For Bhitarkanika, the combined JM-SAM (TAN) and (SIN) measures improved the performance of individual SAM by (16.1 %, 15%) and of JM by (10.3%, 9.2%) respectively.
Development of Flood Inundation Libraries using Historical Satellite Data and DEM for Part of Godavari Basin: An Approach Towards Better Flood Management
Authors: Bhatt C. M. , Rao G. S. , Patro B.
Published: December 2014

Abstract. Conventional method of identifying areas to be inundated for issuing flood alert require inputs like discharge data, fine resolution digital elevation model (DEM), software for modelling and technically trained manpower to interpret the results meaningfully. Due to poor availability of these inputs, including good network of historical hydrological observations and limitation of time, quick flood early warning becomes a difficult task. Presently, based on the daily river water level and forecasted water level for major river systems in India, flood alerts are provided which are non-spatial in nature and does not help in understanding the inundation (spatial dimension) which may be caused at various water levels. In the present paper a concept for developing a series of flood-inundation map libraries two approaches are adopted one by correlating inundation extent derived from historical satellite data analysis with the corresponding water level recorded by the gauge station and the other simulation of inundation using digital elevation model (DEM's) is demonstrated for a part of Godavari Basin. The approach explained can be one of quick and cost-effective method for building a library of flood inundation extents, which can be utilized during flood disaster for alerting population and taking the relief and rescue operations. This layer can be visualized from a spatial dimension together with other spatial information like administrative boundaries, transport network, land use and land cover, digital elevation data and satellite images for better understanding and visualization of areas to be inundated spatially on free web based earth visualization portals like ISRO's Bhuvan portal (http://bhuvan.nrsc.gov.in). This can help decision makers in taking quick appropriate measures for warning, planning relief and rescue operations for the population to get affected under that river stage.
Evolution of surface velocities and ice discharge of Larsen B outlet glaciers from 1995 to 2013
Authors: Wuite J. , Rott H. , Hetzenecker M. , Floricioiu D. , De Rydt J. , Gudmundsson G. H. , Nagler T. , Kern M.
Published: December 2014

Abstract. We use repeat-pass SAR data to produce detailed maps of surface motion covering the glaciers draining into the former Larsen B ice shelf, Antarctic Peninsula, for different epochs between 1995 and 2013. We combine the velocity maps with estimates of ice thickness to analyze fluctuations of ice discharge. The collapse of the central and northern sections of the ice shelf in 2002 led to a near-immediate acceleration of tributary glaciers as well as of the remnant ice shelf in Scar Inlet. Velocities of the glaciers discharging directly into the ocean remain to date well above the velocities of the pre-collapse period. The response of individual glaciers differs and velocities show significant temporal fluctuations, implying major variations in ice discharge and mass balance as well. Due to reduced velocity and ice thickness the ice discharge of Crane Glacier decreased from 5.02 Gt a−1 in 2007 to 1.72 Gt a−1 in 2013, whereas Hektoria and Green glaciers continue to show large temporal fluctuations in response to successive stages of frontal retreat. The velocity on Scar Inlet ice shelf increased two- to three fold since 1995, with the largest increase in the first years after the break-up of the main section of Larsen B. Flask and Leppard glaciers, the largest tributaries to Scar Inlet ice shelf, accelerated. In 2013 their discharge was 38%, respectively 45%, higher than in 1995.
The Bartlett, Architectural Pedagogy and Wates House – An Historical Study
Authors: White Amalie
Published: December 2014

As Wates House, the Faculty building of the Bartlett School of Architecture, is soon to be completely refurbished, stripped to its bare bones and rebuilt upon its current foundations, the physical trace of what the Bartlett School was supposed to embody in Wates House will soon be lost. Using historical archives from the architectural press, UCL literature, oral interviews, carried out in 2013–14, as well as personal experience of using the building as a student, this article provides an explanatory overview of how the history of architectural pedagogy and its reform in the 1960s came to design a very specific building, reflecting not only pedagogy, but the cultural and economic climate of Britain at that time. Ever since, Wates House has created both resistance and harmony towards the practice of architectural education at the university.
Nitrification Control Strategies: What is Nitrification and How is it Managed?
Authors: Skadsen Janice , Reilley Betsy , Gupta Kimberly , Fiske Peter , Moore Randy
Published: December 2014

For any drinking water utility using chloramine disinfection, nitrification is a serious concern. The most important steps utilities can take to manage nitrification are to thoroughly understand their systems' chloramine chemistry, establish an effective monitoring strategy, and deploy multiple preventive strategies holistically throughout their distribution systems.
The Need for Scientific Experiments: The Experience of Pre-service Science Teachers
Authors: Jain Jasmine , Abdullah Nabilah , Lim Beh Kian
Published: December 2014

The availability of scientific information nowadays necessitates scientifically literate learners and teachers well-versed in both content and nature of science (NOS). Despite a clear description of NOS in the Malaysian Education Blueprint, NOS elements have been sidelined by educational practices in Malaysia. This study illuminates the conceptions of pre-service science teachers in Malaysia about one aspect of NOS— the purpose for scientific experimentation. A phenomenographic approach was used to achieve this aim where 10 pre-service teachers were interviewed. Findings revealed three categories, namely a) Experiments prove, b) Experiments invent, and c) Experiments support ideas. The findings also inferred that there are more ways to conceptualise the purpose of scientific experiments other than what has been previously reported. This paper concludes with suggestions on improving the current practices of experimentation in schools and calls for a rethink on the current teachers’ preparatory course in Malaysia.
The Meaning of Health and Help-Seeking Behaviours Among Refugees Who Have Experienced Collective Violence Prior to Emigration: A Canadian Perspective
Authors: Mabaya Gracia , Ray Susan L.
Published: December 2014

An interpretative phenomenological approach with a purposive sample of 3 men and 3 women was employed to explore the meaning of health and help-seeking behaviours of refugees living in Canada who have experienced collective violence in their countries of origin. Prior to migration, the participants’ meaning of health and help-seeking behaviours were fashioned by their embodied experience of life as nonexistent and meaningless. Post migration, their past lived experience of collective violence continued to shape their perceptions of their health and help-seeking behaviours. Participants call for a restructured system offering specialized mental health services for this population.
Clinical Pearl: Levamisole-induced vasculitis with necrosis in chronic cocaine users
Authors: Winistoerfer Niccole M.
Published: December 2014

This case reveals an additional risk faced by persons who abuse substances, specifically when such substances are adulterated. Levamisole, often used to falsely extend the quantity of cocaine a person believes he is purchasing, is known to have life-threatening adverse events. In this case, a chronic cocaine user developed vasculitis from impure cocaine.
Lithium as augmentation for major depressive disorder
Authors: Geier Michelle
Published: December 2014

Although lithium does not have an FDA approved indication for augmentation of an antidepressant in major depressive disorder, it has been prescribed for this purpose for decades. While a wide variety of medications have been used historically in this capacity, lithium is one of the few agents that has demonstrated efficacy in multiple randomized controlled trials. Although the ideal role for lithium augmentation has yet to be established, there is currently ample evidence to support the clinical practice of adding lithium to conventional antidepressants in pursuit of major depressive disorder remission.
Parkinson disease: A summary of recent evidence-based medicine reviews
Authors: Chen Jack J.
Published: December 2014

Parkinson disease (PD) is a complex movement disorder in which the symptomatology, severity and progression vary substantially among patients. Therefore, there is a need to individualize patient therapy. Factors that should be considered when individualizing therapy include published guidelines, practice parameters, and Evidence Based Medicine (EBM) reviews, as well as clinical experience and judgment, patient specific factors and preferences, consensus and expert opinions, and health economic constraints. This article discusses EBM findings regarding treatment of the motor symptoms and the non-motor symptoms associated with PD.
Impact of pharmacist-led or co-led medication education groups on patient outcomes: A literature review
Authors: Norman Sarah , Davis Erica , Goldstone Lisa W.
Published: December 2014

Introduction: Psychiatric pharmacists lead groups for patients with mental health disorders in a variety of locations. It is unknown whether these groups are effective in increasing patient knowledge and adherence or reducing negative healthcare outcomes. It is also unclear whether certain modalities of pharmacist-led medication education groups are more effective than others.

Methods: A literature search using MEDLINE and PsycINFO was performed using the search terms “medication,” “patient education,” “pharmacy” or “pharmacist,” and “psychiatric” or “behavioral” or “mental.” Full text articles of randomized controlled trials or those with a pre-post study design that reported outcomes of a pharmacist-led or coled medication group were included.

Results: Six studies were included in the review, many of which were limited by small sample sizes and confounding factors. These studies suggest that pharmacist-led group medication education can improve cardiac risk factors in patients with diabetes, increase inhaler medication compliance in patients with asthma or chronic obstructive pulmonary disease, and improve the ability of pediatric patients and their parents to manage asthma. Elderly patients' ability to manage their medications improved in one study, but was only shown to be significant for patients using four or more medications in another study. Appropriate medication use by psychiatric outpatients was significantly improved with a pharmacist intervention while decreasing total drug and salary costs.

Discussion: Group interventions provided by pharmacists can be successful in improving patient care outcomes for a variety of disease states in diverse patient populations such as pediatrics and geriatrics. Further research is needed to evaluate the full impact of pharmacist-led medication education groups on outcomes such as patient attitudes, knowledge, patient ability to self-manage medications, adherence, and utilization of health care resources.
Anticonvulsant effects of SSRIs
Authors: Hong Lisa , Bainbridge Jacquelyn L.
Published: December 2014

Although it has previously been thought that serotonin reuptake inhibitors (SSRIs) increase seizure risk, recent evidence suggests that the risk of seizures comes from an underlying deficiency in serotonin rather than the pharmacologic treatment. This article reviews some of the theories on the mechanisms behind seizures, and how antidepressant therapy, particularly SSRIs, could affect the risk.
Was it worth the weight? - Drug review on two new weight loss agents: lorcaserin (Belviq®) and phentermine/topiramate ER (QsymiaTM)
Authors: Crawford Aaron , Kreys Tiffany-Jade
Published: December 2014

The prevalence of obesity in the United States (U.S.) is currently at 34%. This article will review two of the newer weight loss agents: lorcaserin and phentermine/topiramate. Mechanism of action, dosing, adverse events, and drug interactions will be discussed.
Establishing and promoting the CPNP Collegiate Chapter at Purdue University
Authors: Lentz Caitlin , Roman Nora , Dimitrievski Gabriela , Gokhale Anushri
Published: December 2014

The Purdue collegiate chapter of CPNP, established in the fall of 2010, was one of four pilot chapters launched across the nation. This article will discuss the development, implementation, of the chapter. Chapter involvement in the community and fundraising events will also be discussed.
A review of atypical antipsychotics and their utility in post-traumatic stress disorder
Authors: Connell Robert , Zeier Kathryn , Thomas Christopher J.
Published: December 2014

Post traumatic stress disorder (PTSD) is a chronic and debilitating mental illness. Atypical antipsychotics are often utilized for treatment of PTSD despite the limited data. The purpose of this article is to review published clinical trials of atypical antipsychotics used in the treatment of PTSD. Certain patients may benefit from therapy with an atypical antipsychotic, particularly for those with hyper-arousal or re-experiencing symptom clusters. At this time, guidelines suggest against the use of risperidone as augmentation therapy in patients with PTSD. Data are only available for olanzapine, quetiapine, and aripiprazole; however, data were conflicting, not very robust, and studies had limited sample sizes and narrow demographics. It is important to provide proper patient education and weigh the risks versus benefits of therapy with an atypical antipsychotic as metabolic side effects are well documented.
Prazosin treatment of nightmares related to post-traumatic stress disorder
Authors: Lorenz Raymond A. , Hayes John W. , Saitz Marianne
Published: December 2014

This case demonstrates the efficacy of prazosin in treating civilian post traumatic stress disorder (PTSD)-related nightmares. Although its mechanism is not fully elucidated, it is clear that prazosin decreases nightmares. Tolerability may limit one's ability to titrate to an effective dose.
Established and emerging PTSD treatments
Authors: Gaffney David
Published: December 2014

Identifying and describing the numerous types of interventions to treat post-traumatic stress disorder (PTSD) can be a daunting task especially with the numerous therapeutic models and techniques with published case study support. This article will explore the physiology and neurobiology of PTSD. Additionally, it will discuss some of the most common categories of interventions and examples of each (e.g., prolonged exposure therapy, cognitive processing therapy, emotional freedom techniques, reprocessing therapy). Data on d-cycloserine, nabotulinumtoxin A, and methylenedioxymethamphetamine will also be elucidated.
Second- and third-hand smoke exposure: Selected literature for healthcare professionals providing home-based services to the severely mentally ill
Authors: Foster James R. , Washington Nicole B. , Brahm Nancy C.
Published: December 2014

Purpose: To develop recommendations for healthcare professionals at risk for exposure to secondhand (SHS) and thirdhand smoke (THS) while providing home-based services to patients with severe mental illnesses (SMIs), such as schizophrenia.

Summary: Healthcare professionals who provide services to those with SMIs have the potential to be exposed to SHS and THS. Smoking rates in persons diagnosed with schizophrenia are significantly higher compared to the general population (up to 90% versus approximately 30%). According to one study, only 31.5% of patients with SMIs are likely to have smoke-free homes. Currently there are no guidelines available for minimizing the effects of SHS and THS on healthcare professionals. Strategies for minimizing the effects are proposed.

Conclusion: Literature dealing with the effects of SHS, potential occupational hazards of exposure, and the results of anti-public smoking laws to address the problem were reviewed. The health hazards of THS exposure are an emerging area. Data are limited on alternative strategies for healthcare professionals to minimize SHS and THS exposure. Suggestions to minimize exposure are provided.
Development of a collaborative psychiatric advanced pharmacy practice experience
Authors: Caballero Joshua , Marino Jehan , Morales Marlene , Hinkes Roberta
Published: December 2014

Introduction: Faculty are required to balance multiple duties, including, but not limited to teaching, precepting, and scholarly activity. Likewise, pharmacy managers with faculty appointments are challenged with balancing teaching and administrative duties. With increasing numbers of pharmacy students enrolled in colleges of pharmacy and the recent economic decline, there are concerns that increased responsibilities of faculty and preceptors may lead to sub-optimal advanced pharmacy practice experiences (APPEs).

Objectives: Describe a collaborate approach in teaching a psychiatric APPE allowing for additional time for other responsibilities while providing a favorable environment for students.

Methods: Pharmacy faculty and managers developed a collaborative psychiatric APPE. The pharmacists divided lectures and case discussions. Students were given many responsibilities (e.g., counseling, intervention documentation). Preceptor evaluations were documented and evaluated.

Results: Sixty-four students were precepted over two years. Student evaluations of APPE preceptors averaged 3.74/4.00. Additionally, faculty and pharmacy managers accomplished other activities.

Conclusion: It appears this collaborative team taught approach succeeded in providing an auspicious environment for students while allowing preceptors to be productive.
Opioid induced hyperalgesia: A focus on opioid use in chronic pain
Authors: Cunningham Julie L.
Published: December 2014

Opioids are a well-established treatment option for chronic pain. However, opioid therapy is associated with many side effects, including opioid induced hyperalgesia (OIH). This article reviews studies which have evaluated OIH in chronic pain patients on opioids.
Urea cycle disorder
Authors: Allen Shari N.
Published: December 2014

Urea cycle disorder is a rare genetic disorder in which there is a full or partial deficiency in the enzymes of the urea cycle, causing a defect in the metabolism of excess nitrogen, and leading to hyperammonemia. This article reviews the clinical presentation, diagnosis, treatment, and drug-disease state implications of urea cycle disorders.
The use of antipsychotics in maintenance treatment of bipolar disorder
Authors: Turner Traci L.
Published: December 2014

Antipsychotics are often used in the treatment of the acute phase of bipolar disorder; however, once the acute phase has resolved and patients enter the maintenance phase, there is some debate as to whether or not to continue the antipsychotic. This article reviews studies examining the use of antipsychotics in the maintenance phase of bipolar disorder.
Sharing Singapore's experience: The Joint Commission International accreditation of a psychiatric hospital
Authors: Wijesinghe Ruki
Published: December 2014

The United States (US) has successful accreditation systems for their healthcare facilities and this perception continues to grow globally. As one would assume, worldwide standards of assessment are not the same as standards for facilities within the US. Joint Commission International (JCI) has a comparable but different set of standards that have been developed to incorporate unique economic, social, and cultural differences.

Presently, the JCI standards for international psychiatric facilities are the same as the standards set for international hospitals. Institute of Mental Health, an acute tertiary psychiatric hospital in Singapore, has received JCI hospital accreditation consecutively since 2005. ‘Medication Management and Use’ is an important component of the survey process. Product selection, storage, administration and monitoring of medication effects are complex and require expertise to achieve high levels of patient safety. Certain standards and processes that are implemented, measured and undertaken by the pharmacy department are addressed.

The benefits of a JCI accreditation are countless for the organization involved. Considered as the international gold standard for hospitals, successive JCI accreditations illustrate that a healthcare organization is committed to improving safety and quality of patient care by continually striving to reduce risks.
Use of antidepressants during pregnancy and lactation
Authors: Norris Meghan M.
Published: December 2014

The prevalence of depression among pregnant women has been estimated to be 7 to 19 percent. Untreated depression has been associated with poor outcomes for both the mother and neonate. Antidepressant use during pregnancy has been associated with similar outcomes. This review will evaluate the risks and benefits of antidepressant use during pregnancy and lactation.
Oh baby! A review of mood stabilizers for bipolar disorder in the child-bearing woman
Authors: Tillery Erika E. , Tonet Rikki L. , Trahan Christine A.
Published: December 2014

Background: Bipolar disorder is a brain disorder that can cause abnormal changes in a person's mood, cognitive function, and quality of life. Patients who are diagnosed with bipolar disorder often have intense emotional states that are characterized by either manic or depressive episodes. There is a strong correlation between women of child bearing age and the initial age of onset of the disease. Mood stabilizing drugs have been the mainstay of treatment for many decades; however, there is strong data supporting the teratogenic effects of these drugs on the fetus in pregnant and lactating women.

Methods: Review articles, clinical trials, and practice guidelines were located using online databases PubMed, CINAHL, IDIS, and Medline. Search terms included at least one of the following: “bipolar disorder”, “breast-feeding”, “carbamazepine”, “epilepsy”, “lactation”, “lamotrigine”, “lithium”, “mood stabilizers”, “pregnancy”, “valproate”, and “valproic acid”. Online clinical databases Clinical Pharmacology and Lexi-Comp were also used in the study.

Results: All mood stabilizer drugs are found to cause malformations in fetal development if given during the first trimester of pregnancy, thus use should be avoided if possible. Lamotrigine was found to cause lowest risk of adverse effects in both the mother and fetus during pregnancy; however, it should be avoided in breastfeeding women as it readily passes into breast milk. Lithium use during pregnancy and lactation has been associated with severe malformations and should only be used if maternal benefit outweighs fetal risk. Valproate is considered harmful to both the mother and fetus during pregnancy, but may be a compatible option for breastfeeding. Carbamazepine is found to cause serious malformations with the developing fetus as well as metabolic effects with the mother; however, it is found to cause little effects in breastfed infants as it does not readily pass through breast milk.

Conclusion: The use of medications in pregnant and breastfeeding women suffering from bipolar disorder must be carefully considered for impacts on fetal development as well as risks to the mother. Mood stabilizers are readily marketed as first line treatment options for bipolar disorder; however, their use in pregnant and lactating women may cause limitations as preferred therapy. Studies show that though lamotrigine has not been as well studied as the other agents, it may be the best recommendation during pregnancy, for both fetal and maternal health concerns. For breastfeeding women, carbamazepine has been shown to be the better option, as it carries the lowest risk of adverse events to the infant.
Comparing current practices of screening for pregnancy and contraceptive use in female veterans of child-bearing age prescribed psychotropic medications in a mental health versus a women's health clinic
Authors: Zacher Jennifer , Peterson Jeanne , Lempicki Kelly , Zaror Patricia
Published: December 2014

Pregnancy screening and contraceptive counseling are essential components of treating female patients with psychiatric illness to avoid placing the mother or fetus at risk if pregnancy occurs during treatment. The primary objective of this study was to evaluate current practices for pregnancy and contraception screening in female veteran patients prescribed psychotropic medications at a Veterans Affairs/Department of Defense (VA/DoD) facility.
Evaluation of the link between chronic antipsychotic use and osteoporosis
Authors: Downs Rohini , Mathys Monica
Published: December 2014

Background: Patients with schizophrenia are at increased risk for developing osteoporosis, which has historically been attributed to poor diet and lack of exercise. However, more recent data suggest a link between antipsychotic use and osteoporosis due to increased prolactin levels. Hyperprolactinemia can lead to suppression of hypothalamus-pituitary axis regulation of sex hormone production and over time, hypogonadism, which can affect bone health. There have been a few studies evaluating the link between antipsychotic use and osteoporosis; however, the link is not well established and there is very little guidance regarding monitoring of prolactin levels.

Objectives:Determine the prevalence of osteoporosis in patients receiv ing antipsychotic medications.

Evaluate the duration of antipsychotic therapy, prolactin levels (prevalence of monitoring and mean levels), and incidence of fractures for the study patients diagnosed with osteoporosis.

Methods:The study was a retrospective cohort study evaluating patients 18 years of age and older who were prescribed an antipsychotic at the Dallas VA Medical Center from 1/1/2008-12/31/2009. The patients included had to be taking the same antipsychotic for at least one year. Subjects were excluded if they had significant co-morbidities or were taking other medications that increase osteoporosis risk. Patient demographics, antipsychotic information, and pertinent lab values such as vitamin D, prolactin, testosterone and FSH/LH levels were recorded. The use of other medications that may increase prolactin, smoking status, bone mineral density, and history of fracture were also noted.

Results:This study showed that 26% of patients taking antipsychotics for at least one year develope d osteoporosis. The dose or type of antipsychotic (prolactin-sparing versus prolactin-raising) did not appear to be contributing factors. Based on this study's data, the duration of antipsychotic therapy and the concurrent use of other prolactin raising medications may be more concerning.
Dynamics of drug evaluation: Formulary placement of antipsychotics
Authors: Mascareñas Cynthia A. , Oliveira Rosana
Published: December 2014

Formulary management for psychotropic medications can be more difficult compared to other medication classes, as the same medications can produce significantly different results in individual patients. This article reviews various factors which should be examined when deciding which antipsychotics to include on a formulary.
Depression screening in uninsured patients in a primary care setting
Authors: Borja-Hart Nancy , Wooten Audrey , Debile Tina
Published: December 2014

There is a strong correlation between chronic disease and depression; however, screening patients for depression is not typical in the primary care setting due to factors such as time constraints and the provider's ability to diagnose and manage depression. This study sought to: (1) determine the prevalence of depression in uninsured or underinsured patients with chronic diseases using a screening instrument validated for use in the primary care setting, (2) provide a referral to the patient's primary care provider (PCP) for depression management prior to disease management as needed, and (3) enroll patients for chronic disease management services. The study utilized a cross-sectional design consisting of a self-administered survey and medical record review after physician and nursing appointments. Patients completed the Beck Depression Inventory for Primary Care (BDI-PC) upon program enrollment. Patients that screened positively for depression were referred to the PCP for follow-up services prior to entry into one of the disease management programs. After PCP appointments took place, medical records were reviewed to obtain medical and depression diagnoses, along with mediation recommendations. Forty-one patients were enrolled in the clinic program and completed the depression screening. Eight patients were found to have mild depression and two patients had moderate depression as determined by the BDI-PC, which accounted for 24% of the clinic patients. Four of the patients with mild depression and both patients with moderate depression initiated antidepressant therapy. Additionally, three patients with minimal scores on the screening began medication therapy based on symptoms reported to the PCP. The results of this study suggest that it is feasible to incorporate a depression-screening tool in a primary care setting with further evaluation and follow-up by primary care providers.
STEPS for cost-effective prescribing of serotonin-norepinephrine reuptake inhibitors (SNRIs) in major depressive disorder: Focus on venlafaxine (Effexor®) versus duloxetine (Cymbalta®)
Authors: Alipour Azita
Published: December 2014

Selection of an antidepressant medication is based on various factors, such as safety, tolerability, and cost. This article reviews the cost-effectiveness of the different serotonin-norepinephrine reuptake inhibitors (SNRIs).
Electronic cigarettes in smoking cessation
Authors: Scheer Corey E.
Published: December 2014

Background: Tobacco use is the most prevalent preventable cause of death in the United States, accounting for approximately 20% of all deaths each year. Despite available treatment options, many smokers still experience multiple failed quit attempts indicating a need for development of novel therapies. When the electronic cigarette (e-cigarette) was introduced to the United States' market in 2007, patients began to discuss its possible use as the newest form of nicotine replacement therapy (NRT).

Methods: A PubMed search was performed for the following terms: “Electronic cigarettes, e-cigarettes, and smoking cessation”. A manual search of references from articles found was performed to identify additional relevant articles.

Results: Most evidence surrounding use of e-cigarettes for smoking cessation is found in self-reports and user surveys. One study looking at short-term effects of e-cigarettes on desire to smoke found a decreased desire in subjects inhaling from both nicotine-containing and placebo e-cigarettes. Three studies from Italy looked at natural reduction of cigarette use when subjects were allowed to freely use e-cigarettes. All three studies showed a natural reduction indicating potential efficacy for e-cigarette use in smoking cessation. A recently published randomized controlled trial was unable to prove superiority of e-cigarettes over transdermal nicotine patches for smoking cessation.

Conclusions: A few studies have explored the possibility of replacing tobacco cigarettes with e-cigarettes to facilitate a natural reduction in use and have shown minimal positive results in a population not intending to quit. A recent randomized controlled trial comparing e-cigarettes with nicotine patches for smoking cessation was unable to prove superiority. Until these products are regulated and efficacy can be shown with well-designed studies, e-cigarettes are not a viable treatment for use in smoking cessation or as nicotine replacement therapy.
Melatonin agonists in the management of sleep disorders: A focus on ramelteon and tasimelteon
Authors: Adams Katie S. , Breden Crouse Ericka L.
Published: December 2014

Melatonin agonists have become an area of interest in the treatment of sleep disorders. This article reviews the available data on this class of medications, with a focus on ramelteon and tasimelteon.
Treatment of sleep disturbances in post-traumatic stress disorder
Authors: Tomas Megan
Published: December 2014

Sleep disturbances are very common in patients suffering from post-traumatic stress disorder (PTSD) and can have various negative sequelae, including worsening of perceived levels of stress, depression, and suicidal ideation. Although PTSD treatment can lead to improved sleep in some patients, there are a number of patients whose sleep disturbances do not remit even after treatment and can persist long after the original trauma. There are various non-pharmacological and pharmacological treatment modalities that have been studied. Non-pharmacological therapies include image rehearsal therapy (IRT), cognitive behavioral therapy for insomnia (CBTI), prolonged exposure (PE), and eye-movement desensitization and reprocessing (EMDR). Pharmacological studies include alpha-1-adrenergic receptor antagonists, alpha-adrenergic agonists, selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) monoamine oxidase inhibitors (MAOIs), other antidepressants, atypical antipsychotics, benzodiazepines, sedative hypnotics, and antiepileptics. The therapies with the most evidence to support their use are Image Rehearsal Therapy (IRT) and the alpha-1-adrenergic receptor antagonist, prazosin.
An overview of clinically significant drug interactions between medications used to treat psychiatric and medical conditions
Authors: Hoeft Dawn
Published: December 2014

Prescription rates and polypharmacy are increasing, resulting in a greater potential for drug interactions. Psychiatric patients frequently have co-morbid medical conditions, which further increases the risk of polypharmacy and drug interactions. Drug interactions that affect drugs with narrow therapeutic windowsare of particular concern. This review presents some of these drug interactions and provides strategies for identifying and resolving them.
Assessment and management of chronic pain in patients with depression and anxiety
Authors: Hoffelt Charity , Zwack Andrew
Published: December 2014

This article will review the role of the pharmacist in the management of chronic pain in patients with comorbid mood disorders.
Emerging therapies for treatment resistant depression
Authors: Wijesinghe Ruki
Published: December 2014

Despite new insights and evidence-based treatment options for clinical depression in the recent years, the current choices of safe and effective therapies are still inadequate to sustain a long-term response in the depressed patient. Many do not improve, improve partially or are classified as ‘treatment resistant’ with poor compliance and marked functional impairment. The aim of this article is to review future therapeutic options and advances in treatments available for this cohort of patients. Several innovative and promising studies are underway to explore the role of ketamine, a glutamate N-methyl-d-aspartate (NMDA) antagonist in treating treatment-resistant depression and acute suicidal ideation. Furthermore, new research reveals that depression is associated with a significant drop in neurotrophic factors such as brain derived neurotrophic factor (BDNF) and increasing BDNF may be a new strategy for developing new antidepressants. Neuromodulation interventions by stimulating specific brain regions including deep brain stimulation (DBS), magnetic seizure therapy (MST), and transcranial direct current stimulation (tDCS), still in experimental stages, are also discussed.
Pharmacogenomic testing for treatment resistant depression
Authors: Leckband Susan G.
Published: December 2014

The percentage of patients who have failed to completely or partially respond to multiple trials of antidepressants at adequate doses and for an adequate duration of therapy has varied in the literature and is considered substantial. Numerous strategies exist to treat poor antidepressant response, but often medications are selected on a “trial and error” basis. Genetic factors may play a role in poor response or intolerance to treatment with antidepressants which lead to treatment failures. Currently, available genetic testing as well as genetic testing currently under research may help guide clinicians with proper medication and dose selection.
Special populations: Treatment resistant mood disorders
Authors: Guinta Gina M. , Graham Rebecca L.
Published: December 2014

Mood disorders are highly prevalent throughout the United States, and high rates of relapse, recurrence, and treatment failure lead to treatment resistance. This article will review the available literature and treatment recommendations for treatment resistant mood disorders in special populations including: geriatrics, children and adolescents, pregnancy, and comorbid substance use disorders.
Integration of a clinical pharmacist into the healthcare home (HCH)
Authors: Gable Kelly N.
Published: December 2014

Mental health is intrinsically linked to general medical health. People with severe and persistent mental illnesses (SPMIs) have been reported to have higher rates of infectious diseases, type 2 diabetes, respiratory illnesses, and cardiovascular disease. They also have 1.5 to 2 times the prevalence of dyslipidemia, hypertension, and obesity than the general population. Healthcare Homes (HCHs) are an integrated treatment approach allowing for psychiatric and medical conditions to be addressed collaboratively. The HCH model promotes open communication among healthcare providers, wellness education, and preventative care. Physicians and nurses are mandatory providers within the HCH. Pharmacists are not routine members of this new approach to care. This article will describe an example of how psychiatric pharmacy services have been incorporated into a HCH. It also calls for advocacy within the specialty of psychiatric pharmacy in an effort to encourage state and government policy changes that mandate the addition of pharmacists into the HCH model of care.
Reprise: The effect of metformin on anthropometrics and insulin resistance in patients receiving atypical antipsychotic agents: A meta-analysis
Authors: Ehret Megan J
Published: December 2014

Atypical antipsychotics are well-established agents for the treatment of various psychiatric illnesses, although they are associated with adverse metabolic effects. There have been a few methodologically sound studies that have assessed the approach of adding metformin to atypical antipsychotics to reduce body weight. A systematic literature review of MEDLINE, EMBASE, and Cochrane was performed from the earliest possible dates to December 31, 2008. Metformin was found to be associated with a decrease in weight, waist circumference, bmi, and insulin resistance (p<0.005). The data supports the consideration of metformin for the reduction of metabolic effects developed from the atypical antipsychotics in clinical practice. Ultimately, additional rigorous controlled trials with the various antipsychotics and at different time points in the development of the metabolic effects are needed.
Fostering the use of clozapine in the severely mentally ill through academic detailing
Authors: Farhadian Sanaz , Yee Monica V. , Christopher Melissa L.D.
Published: December 2014

Academic detailing is an educational program in which independent researchers and clinicians evaluate available literature to develop up-to-date, unbiased, evidence-based recommendations for a given therapeutic area. Pharmacists, nurses, and physicians trained as academic detailers then disseminate this information to providers. This is one means to foster the greater use of clozapine in patients with treatment-resistant schizophrenia. The Veterans Health Administration (VHA) Academic Detailing Service meets with mental health providers at each facility to identify barriers and healthcare systems solutions, provide feedback about prescribing and patterns of care, and develop and distribute educational materials to improve veteran health outcomes. Preliminary results include a reduction in polypharmacy antipsychotic use from 17% of patients on antipsychotics to 12.2% of patients (p<0.001). Although there was a numeric increase clozapine new starts in the 5-month interim analysis, the increase was not significant in this analysis. Analysis for 12-month data is underway. The early success of this program demonstrates there may be opportunity for this type of educational intervention in the Veterans Affairs Healthcare System.
New Drug Review: Clobazam (Onfi®) - A “new” anticonvulsant option
Authors: Holmes Jamie , Hieber Robin
Published: December 2014

Clobazam was approved by the Food and Drug Administration (FDA) in October of 2011. This article reviews clinically significant aspects of this new drug including: the FDA-approved indications, mechanism of action, administration, drug interactions, adverse effects, clinical trial evidence, innovative properties and place in therapy.
Viibryd (Vilazodone): Viable option or for the byrds?
Authors: Gonzalez Misty L.
Published: December 2014

Vilazodone was approved by the Food and Drug Administration (FDA) in January of 2011. This article reviews clinically significant aspects of this new drug including: the FDA-approved indications, mechanism of action, administration, drug interactions, adverse effects, clinical trial evidence, innovative properties and place in therapy.
Are extrapyramidal symptoms less recognized? Case report of modern practitioners' unfamiliarity with first generation antipsychotics
Authors: Purvis Tara L.
Published: December 2014

A case is presented where initial suspicion of lithium toxicity was mistaken. Drug-induced Parkinsonism and tardive dyskinesia were present, underscoring the need to improve training of movement disorder assessment.
Lithium and valproate-induced tremors
Authors: Canning Jacquelyn E. , Burton Stephanie , Hall Beth
Published: December 2014

Lithium and valproate are mood stabilizers known to cause tremor. This article concisely addresses etiological questions, expected time frame of tremor onset, and treatment options for this medication-induced side effect. Along with dosage modifications of the tremor-inducing medication, authors review evidence from small trials of adjunctive treatment modalities.
Applied monitoring for tardive dyskinesia and other extrapyramidal side effects
Authors: Kalachnik John E.
Published: December 2014

While the rate of tardive dyskinesia (TD) and other extrapyramidal side effects (EPSE) is lower with second generation antipsychotic medications compared to first generation antipsychotic medications, these side effects remain of clinical concern. This paper reviews the basis for the continued concern and the importance of secondary prevention, or early detection, within the primary-secondary-tertiary prevention model. The importance of standardized assessment instruments, education, and training is reviewed. Given the widespread use of antipsychotic drugs, the fact that antipsychotic drugs are the standard of care for several psychiatric conditions (with little indication that the magic bullet is on the immediate horizon to replace current antipsychotic drugs) applied monitoring and the early detection of TD and EPSE takes on added importance.
The role of turbulent mixing in the modified Shelf Water overflows that produce Cape Darnley Bottom Water
Authors: Hirano Daisuke , Kitade Yujiro , Ohshima Kay I. , Fukamachi Yasushi
Published: December 2014

The mixing process associated with modified Shelf Water (mSW) overflows that eventually mix to form Cape Darnley Bottom Water (CDBW) was investigated by hydrographic and microstructure observations off the Cape Darnley Polynya (CDP), East Antarctica, in January 2009. Closely spaced microstructure observations revealed that mSW properties varied considerably within a distance of ∼4 km across the shelf edge. Near the bottom, the rate of turbulent kinetic energy dissipation was enhanced to values greater than 10−7 W kg−1, and the vertical scale of the bottom boundary layer (BBL) was on the order of 10 m. The observed BBL around the shelf edge was characterized by strong vertical mixing with turbulent eddy diffusivities of
(10−3−10−2) m2 s−1. A geostrophically balanced density current, which resulted from the presence of mSW over the continental shelf, is considered the primary energy source for the turbulent mixing in the BBL. This turbulent mixing transforms the overflowing mSW through mixing with ambient water masses, specifically with the overlying modified Circumpolar Deep Water. The BBL is also thought to partly contribute to the gradual descent of mSW down the continental slope through bottom Ekman transport. We conclude that turbulent mixing, primarily caused by a density current, plays an important role in CDBW formation, by modifying the mSW overflowing from the CDP.