bluuebunny/crossref_metadata_2025 huggingface dataset:
Effective use of hybrid turbine ventilator to improve thermal performance in Malaysian tropical houses
Authors: Al-Obaidi Karam M , Ismail Muhammad Azzam , Abdul Rahman Abdul Malek
Published: May 2016

An efficient design approach that involves extracting heat build-up in tropical buildings is a means to reduce total dependency on air-conditioning systems. The hybrid turbine ventilator can be regarded as a development technique to address this issue. However, identifying its efficient application in buildings remains questionable. This study aims to develop the research on the hybrid turbine ventilator for the establishment of energy-efficient designs in houses by evaluating its effective use in specific space volume based on several empirical comparisons. The performance of passive and hybrid turbine ventilators in attic space, room, and (attic space + room) with opened and closed windows was compared. The study was conducted in an actual building model, and data were collected onsite with a data acquisition system. The objective was achieved by investigation, and the findings can be used to identify the levels of heat build-up in each strategy. Examination of thermal performance confirmed the appropriate use of the hybrid turbine ventilator in Malaysian landed houses.

Practical application:This research contributes directly to energy efficient design in tropical buildings. The outcomes inform a better decision on the effective use of hybrid turbine ventilator in low-rise buildings. The study provides ample evidence on the great potential of using hybrid turbine ventilator by developing its investigation in tropical architecture. The study will assist engineers and architects to evaluate hybrid turbine ventilator performance effectively.
“He Hath Builded the Mountains”
Authors: Willis Paul J.
Published: May 2016

While the writer and naturalist John Muir may have disposed of his father’s Christocentric theology, he nevertheless firmly retained his faith in a loving Providence. For Muir, this divine love was best expressed in the power of glaciers to carve stunningly beautiful mountain landscapes, such as those in the Sierra Nevada, into their “predestined” forms. Muir was not only in the minority among 19th-century naturalists in his conviction that glaciers were the major force to have shaped the Sierra; he was also in the minority among Romantic and Victorian writers in his belief that glaciers are uniquely divine instruments in the ongoing creation of the beautiful.
Integration of land use, land cover, transportation, and environmental impact models: Expanding scenario analysis with multiple modules
Authors: Shahumyan Harutyun , Moeckel Rolf
Published: May 2016

It is an expensive and time-consuming task to develop a new model. Furthermore, a single model often cannot provide answers required for complex decision making based on multiple criteria. Coupling models are often applied to make use of existing models and analyze complex policy questions. This paper provides an overview of possible model integration approaches, briefly explains the modules that were integrated in a particular application, and focuses on the integration methods applied in this research. While the initial attempt was to integrate all models as tightly as possible, the authors developed a much more agile integration approach that allows adding and replacing individual modules easily. Python wrappers were developed to loosely couple land use, land cover, transportation, and emission models developed in different environments. ArcGIS Model Builder was used to provide a graphical user interface and to present the models’ workflow. The suggested approach is especially efficient when the models are developed in different programming languages, their source codes are not available, or the licensing restrictions make other coupling approaches impractical.
The effect of alcohol hangover on choice response time
Authors: Grange James A , Stephens Richard , Jones Kate , Owen Lauren
Published: May 2016

The effect of alcohol hangover on cognitive processing has received little attention. We explored the effect of alcohol hangover on choice response time (RT), a dominant dependent variable (DV) in cognitive research. Prior research of the effect of hangover on RT has produced mixed findings; all studies reviewed relied exclusively on estimates of central tendency (e.g. mean RT), which has limited information value. Here we present novel analytical methods by going beyond mean RT analysis. Specifically, we examined performance in hangover conditions ( n=31) across the whole RT distribution by fitting ex-Gaussian models to participant data, providing a formal description of the RT distribution. This analysis showed detriments to performance under hangover conditions at the slower end of the RT distribution and increased RT variance under hangover conditions. We also fitted an explicit mathematical process model of choice RT – the diffusion model – which estimates parameters reflecting psychologically-meaningful processes underlying choice RT. This analysis showed that hangover reduced information processing efficiency during response selection, and increased response caution; changes in these parameters reflect hangover affecting core decisional-components of RT performance. The implications of the data as well as the methods used for hangover research are discussed.
Factor Analysis and Item Reduction of the Banff Patella Instability Instrument (BPII)
Authors: Lafave Mark R. , Hiemstra Laurie , Kerslake Sarah
Published: May 2016

Background:

Clinical management of patellofemoral (PF) instability is a challenge, particularly considering the number of variables that should be taken into consideration for treatment. Quality of life is an important measure to consider with this patient population.

Purpose:

To factor analyze and reduce the total number of items in the Banff Patella Instability Instrument (BPII). Subsequent to the factor analysis, the new, item-reduced BPII 2.0 was tested for validity, reliability, and responsiveness.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

Quality of life was measured for PF instability patients (N = 223) through use of the original BPII at their initial consultation. Data from the BPII scores were used in a principal components analysis (PCA) to factor analyze and reduce the total number of items in the original BPII, to create a revised BPII 2.0. The BPII 2.0 underwent content validation (Cronbach alpha, patient interviews, and grade-level checking), construct validation (analysis of variance comparing the initial visit and the 6-, 12-, and 24-month postoperative visits, eta-square), convergent validation (Pearson r correlation to the original BPII), responsiveness testing (eta-square, anchor-based distribution testing), and reliability testing (intraclass correlation coefficient [ICC]).

Results:

The BPII was successfully reduced from 32 to 23 items with excellent Cronbach alpha values in the new BPII 2.0: initial visit = 0.91; 6-month postoperative visit = 0.96; 12-month postoperative visit = 0.97; and 24-month postoperative visit = 0.76. Grade-level reading for all items was assessed as below grade 12. The BPII 2.0 was able to discriminate between all time periods with significant differences between groups ( P < .05). Eta-square was 0.40, demonstrating a medium to large effect size. The BPII significantly correlated with the BPII 2.0 (0.82, 0.90, 0.90, and 0.94 at the initial visit and 6-, 12-, and 24-month postoperative visits, respectively), providing evidence of convergent validity. A significant correlation was found between the 7-point scale and 24-month postoperative BPII 2.0 scores, a sign of anchor-based responsiveness. ICC (2,k) was 0.97, indicating strong reliability.

Conclusion:

The BPII 2.0 is valid, reliable, and responsive for assessment of patients with PF instability, both surgically and nonsurgically treated.
A method for evaluating the degradation of edge stretchability incorporating punching damage based on Marciniak and Kuczynski model
Authors: Yu Xiangyu , Chen Jieshi , Chen Jun
Published: May 2016

Edge stretchability refers to a sheet metal’s capability to resist edge cracking during edge forming and flanging. In this article, a quantitative method has been proposed to evaluate the effect of punching or trimming of sheet metals on the degradation of their edge stretchability. This method adopts the Marciniak and Kuczynski concept to quantify edge damages due to punching or trimming. A novel index, the effective failure strain ratio, is introduced. Effective failure strain ratio is strain-based, and it is defined as the ratio of the actual edge failure strain to the theoretical edge failure strain. The algorithm to calculate effective failure strain ratio based on hole-expansion simulations is detailed. The magnitude of effective failure strain ratio depends on the damage value, which corresponds to the edge damage caused by preprocessing such as punching. Numerical studies are conducted to demonstrate the applicability of this method. The results show that the degradation of edge stretchability of materials with higher hardening exponent ( n-value in power hardening law) is more sensitive to edge damage. Hole-expansion experiments using two grades of dual-phase steels are conducted to validate the conclusions deduced from the simulations. The comparison between the experimental and numerical results shows that the proposed method is able to predict phenomena appearing in the experiments. The quantitative relationship between damage value and the punching clearance has not been established in this work yet, which requires extensive experimental investigation. However, a qualitative link has been clearly demonstrated, and this method provides a new perspective to express the pre-damage and its effect straightforwardly.
HIV-related mortality at a district hospital in Botswana
Authors: Perry Melissa EO , Kalenga Kitenge , Watkins Louise Francois , Mukaya Japheth E , Powis Kathleen M , Bennett Kara , Mmalane Mompati , Makhema Joseph , Shapiro Roger L
Published: May 2016

We reviewed mortality data among medical inpatients at a tertiary hospital in Botswana to identify risk factors for adverse inpatient outcomes. This review was a prospective analysis of inpatient admissions. All medical admissions to male and female medical wards were recorded over a six-month period between 1 November 2011 and 30 April 2012. Data collected included patient demographics, HIV status (positive, negative, unknown), HIV testing history, HIV related treatment and serological history, admission and discharge diagnoses, and mortality status at final discharge or transfer. Of 972 patients admitted during the surveillance period, 427 (43.9%) were known to be HIV-positive on admission, 144 (14.8%) were known to be HIV-negative, and 401 (41.3%) had an unknown HIV status. Of those with unknown status, 131 (32.7%) were tested for HIV during admission and among these 35 (27.5%) were HIV-positive. Including patients with known mortality status following transfer, 172 (17.9%) patients died during the hospitalization. Death occurred in 105 (23%) of known HIV-positive patients, compared with 31 (13%) of known HIV-negative patients (p = 0.002, HR = 1.56 in adjusted analyses). Among HIV-positive patients who died, a low CD4 cell count (<200 cells/mm3) was associated with death. Overall, patients who died had significantly more neurological and respiratory-related presenting complaints than patients who survived. In conclusion, we identified higher overall mortality among HIV-positive patients at a tertiary hospital in Botswana, and low rates of in-hospital HIV testing and antiretroviral therapy initiation. These data demonstrate that despite available antiretroviral therapy in the population for over a decade, HIV continues to add excess burden to the hospital system and adds to inpatient mortality in Botswana.
Perinatal sulfamonomethoxine exposure influences physiological and behavioral responses and the brain mTOR pathway in mouse offspring
Authors: Zhang Q , Zhang D , Liu Kai-yong , Liu Ye-hao , Sheng J , Jin Zhong-xiu , Wang Su-fang , Bo Qing-li , Wang Jia-jia , Yin Hui-fang
Published: May 2016

Sulfamonomethoxine (SMM) is widely used in the veterinary field in China. Although some clinical surveys have revealed that sulfonamide antibiotics cause adverse nervous system symptoms, the related mechanisms of maternal SMM exposure on the neurobehavioral development of offspring remain unclear. Here, we investigated the effects of perinatal SMM exposure on the physiological and behavioral responses of pubertal offspring mice and the underlying mechanisms. We randomly allocated pregnant mice into the groups treated with SMM at different doses and the saline-treated groups. Maternal mice were orally administered SMM daily from gestational day 1 to postpartum day 21. On postnatal day (PND) 22, the parameters of growth, endocrine hormones, and brain amino acid composition were assessed, as well as the brain transcript levels of key genes involved in the mammalian target of rapamycin (mTOR) signaling pathway. From PND 50 to 55, a battery of behavioral tests relevant to anxiety and memory were then administered. Analysis of the results indicated that the pups, particularly the pubertal female offspring, showed anxiety-like behavior. Moreover, the pubertal offspring showed cognitive impairments and fat accumulation. Furthermore, the relative mRNA expression of genes involved in the mTOR signaling pathway in females on PND 22 was elevated, whereas the expression of N-methyl-d-aspartate receptor 2B (NR2B) was reduced. Together, the results showed that perinatal SMM exposure perturbs neuroendocrine functions, and further alters gene expression in the mTOR pathway and NR2B gene expression early in life, which may contribute to brain dysfunction in pubertal life.
Organisational and individual support for nurses’ ethical competence: A cross-sectional survey
Authors: Poikkeus Tarja , Suhonen Riitta , Katajisto Jouko , Leino-Kilpi Helena
Published: May 2016

Background:

Nurses’ ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses’ ethical competence is needed.

Research questions:

This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses’ and nurse leaders’ ethical competence, perceptions of support for nurses’ ethical competence at the organisational and individual levels and background factors associated with this support.

Research design:

A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis.

Participants:

The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland.

Ethical considerations:

Ethical approval was obtained from the university ethics committee. Results: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses’ and nurse leaders’ perceptions of provided support for nurses’ ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support.

Conclusion:

Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses’ ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.
Challenges of Democratic Consolidation in Africa: Implications for India’s Investment Drive
Authors: Ng’oma Alex Mwamba
Published: May 2016

In Africa, the dawn of political independence, which many countries experienced in the late 1950s and the early 1960s, ushered in political freedom but not economic prosperity. It was for this reason that the onset of the third wave of democratisation, which culminated into the end of the Cold War in 1989, came to be hailed by the African masses as a second form of liberation. The Africans hoped that democracy, once consolidated, would be the basis for economic development on their continent. This article observes, nonetheless, that democracy in many African countries has not proceeded to the expected phase of democratic consolidation due to several challenges that the article outlines. The article explains further that despite the uninspiring picture of political instability on the continent, Africa is actually home to at least six of the fastest growing economies in the world. The article, thus, suggests that India should not hesitate, but seek to increase its investment portfolio in Africa, since the continent’s unstable political environment is not at all inimical to foreign direct investment.
Optimal shunt parameters for maximising wave attenuation with periodic piezoelectric patches
Authors: Junyi Lee , Balint Daniel Stephen
Published: May 2016

Elastic metamaterials, which have huge potential in wave guiding and attenuation applications, can be built from structures with periodic piezoelectric patch arrays. Passive shunts offer the benefits of simplicity and low cost. In this paper, the effects of the magnitude and phase angle of the shunt impedance on the attenuation constant of a beam with periodic piezoelectric patch arrays were studied in order to determine the optimal shunt that produces the widest and most effective band gaps. The attenuation constants were found to be large when the phase angle is [Formula: see text] rad and when the magnitude decreases exponentially with the excitation frequency. This corresponds to a negative capacitance circuit, which is the optimal shunt for such systems. The attenuation constant of the system reduces significantly when the impedance deviates from the optimal value suggesting other circuits are less effective. The impedance and band structure of resistive–inductive (R-L), negative capacitance and resistive shunts were investigated. As expected, the negative capacitance circuit produces a large band gap, while the R-L circuit only produces a band gap around its natural frequency. The transmissibilities of a finite system with these circuits demonstrated that vibration transmissions are low within the band gaps. Furthermore, the stability of the negative capacitance circuit built using a dual-output second-generation current conveyor (DO-CCII) was examined by studying the pole diagrams. The system was found to be stable in ideal conditions but unstable when parasitic effects are considered. This suggests that the stability of the system is an important consideration for the implementation of this strategy and the different negative impedance converter designs available in the literature should be studied to find a suitable circuit configuration.
The Effects of Price Information on Physician Prescribing Patterns — A Literature Review
Authors: Zelnio Robert N. , Gagnon Jean P.
Published: May 2016

Rising expenditures for drugs under Medicare, Medicaid, and other federally funded programs have prompted the Department of Health, Education and Welfare to adopt regulations aimed at achieving cost containment. The Maximum Allowable Cost (MAC) regulations exemplify this effort. One of the components of these regulations proposes to generate added cost savings by influencing physicians to prescribe lower cost drugs to a greater extent. This would result from the provision of drug cost information to the physicians. The literature was reviewed in an attempt to predict the impact that drug cost information might have on the physician's prescribing decision and reimbursement costs. The conclusion reached is that physicians will not incorporate price information into the prescribing decision to the extent necessary for the achievement of cost savings. An alternative strategy is proposed which utilizes pharmacists to provide prescribers with drug information. This strategy is based on the efficacy of the drug industry's detailmen in providing drug information, the availability of trained manpower, and empirical evidence supporting this activity's cost containment potential. Finally, the need for evaluative research in five areas is suggested prior to the implementation of programs similar to that proposed by HEW.
L-Tryptophan in Psychiatric Practice
Authors: Pakes Gary E.
Published: May 2016

The amino acid L-tryptophan is being prescribed more and more for the treatment of depression. Since L-tryptophan is a precursor to serotonin and crosses the blood brain barrier, it is believed by some investigators to be most effective in depressions secondary to serotonin deficiency. Several studies using L-tryptophan with and without concomitant tryptophan pyrrolase inhibitors, decarboxylase and hydroxylase cofactors, or decarboxylase inhibitors, have indicated its usefulness in combatting depression, but other studies have found it to be of value only as an ancillary drug therapy with tricyclic antidepressants and especially with monoamine oxidase inhibitors. The drug's sedative side effect has prompted several studies which indicate it has some value as a hypnotic agent. L-tryptophan has also been reported to be useful in acute mania, although its mechanism of action in this condition is not well understood. Side effects to L-tryptophan use are minimal, but long-term adverse effects are in question, as certain tryptophan metabolites have been implicated as being in excess in bladder and breast cancers. The greatest utility of L-tryptophan is probably as a concomitant agent with MAO inhibitors, and in depressions that have not responded to tricyclic antidepressants, MAO inhibitors alone, or electroconvulsive therapy.
Indexing and Abstracting Systems
Authors: Schneiweiss Fred
Published: May 2016

The proliferation of information and literature in medicine, therapy, and pharmacy practice in general has created a need for a centralized source of indexing that enables individuals to efficiently locate this type of literature. An excellent example of this type of system would be Index Medicus. But Index Medicus is voluminous and all-encompassing in its coverage. The need for fast, convenient access to publications in specialty areas has led to decentralized specialty indexing and abstracting systems that deal with a particular area of medicine, therapy, or pharmacy practice. This article deals with these specialty systems and encourages their investigation and use when searching the literature.
Hypertension in Pediatrics
Authors: Bosso John A. , Mutchie Kelly D.
Published: May 2016

Hypertension occurring during childhood and adolescence is being recognized more frequently today than in the past. Hypertension in the pediatric population differs from that in adults with respect to incidence, etiology, clinical presentation, and drug treatment. This article reviews both the pathophysiology and drug treatment of hypertension in pediatric patients. A plan for drug management is presented.
The Hospital Pharmacist and Nursing Pharmacology
Authors: Grogan F. James
Published: May 2016

This article attempts to provide some general guidelines to pharmacists who teach pharmacology to student nurses. With proper preparation, the pharmacist-instructor can offer a course that will be rewarding both for him and for his students. To aid the beginning instructor in organizing a course, suggestions are made regarding the organization of a course, methods of instruction, the selection of a textbook, the use of audiovisual aids, the selection of guest speakers, the preparation of tests, and course evaluation. After having read the article, the novice instructor should be able to set clear goals and objectives for his course and to avoid some of the potential pitfalls associated with a course on a complex subject.
Recently Approved Alternatives to Aspirin
Authors: Hovander Greg
Published: May 2016

Antiinflammatory analgesics recently approved by the FDA for use in the United States are evaluated and compared with aspirin and other older agents. The drugs discussed are propionic acid derivatives, tolmetin, and sulindac. Indications, dosages, efficacy, side effects, cost, precautions, and interactions are discussed.

The propionic acid derivatives and tolmetin are structurally different from older drugs and provide new alternatives in the treatment of inflammatory disease and pain. Of these new agents, naproxen appears to be first choice.

Sulindac is the result of efforts to improve indomethacin. It possesses a longer duration of action, and it appears to cause fewer side effects.
Legal and Ethical Issues in Clinical Pharmacy Research — Informed Consent, Part I
Authors: Pathak Dev S. , Foster Thomas S. , Raehl Cynthia L.
Published: May 2016

The continued growth of hospital and clinical pharmacy should be paralleled by the development of sound research methods justifying innovative practices. Such research will, on occasion, require experimentation involving human subjects. The principal means of assuring that the welfare of research participants is not compromised is through the procurement of effective informed consent.

Pharmacists, like many other health professionals, have had relatively little exposure to methodology involved in the writing of an informed consent instrument. A comprehensive document must not only conform to the requirements of federal regulatory agencies, but must also satisfy various institutional guidelines.

Past instances of unethical human experimentation are discussed, and a format for preparation of an informed consent instrument is examined. Circumstances requiring informed consent and identification of the basic elements of consent are also explained.
Comparative Bioavailability of Enteric-Coated Aspirin Preparations
Authors: Bicket William J. , Maynard Susan M. , Sawyer William T.
Published: May 2016

A three-way crossover study was conducted in nine healthy subjects to compare the bioavailability of one uncoated and two enteric-coated aspirin products after the administration of a single 650-mg dose of each preparation. Urine was collected at various intervals for 24 hours after drug administration and assayed for total salicylic acid content as an indicator of bioavailability.

There were statistically significant differences among the three products in the amount of salicylic acid appearing in the urine, both for specific collection intervals and for cumulative (24-hour) excretions. Greater (p < 0.001) amounts of urinary salicylic acid were found in the first three hours after uncoated aspirin treatment than after enteric-coated aspirin administration. After 24 hours, equivalent amounts of salicylic acid were found following treatment with uncoated aspirin and one of the enteric-coated preparations.

The absorption of aspirin from enteric-coated preparations is markedly delayed when compared to that from an uncoated product.
A Review of Complications of Amphotericin-B Therapy: Recommendations for Prevention and Management
Authors: Maddux Michael S. , Barriere Steven L.
Published: May 2016

The pathogenesis, clinical manifestations, and management of adverse reactions of amphotericin B are presented. Various types of nephrotoxicity, thrombophlebitis, and anemia are described along with suggestions for their prevention and management. The management of generalized reactions such as fever, GI upset, headache, and myalgias is discussed, along with a commentary on allergic reactions. Complications associated with intrathecal administration and aerosolization of the drug are also described.
Corticosteroid Therapy for Septic Shock: Review and Analysis
Authors: Quinn Suzanne , Snader Thomas C.
Published: May 2016

The use of corticosteroids in the treatment of septic shock has been a controversial topic since first investigated. Although early studies were inclusive, a brief analysis of these studies highlights their problems. Examining the effects of pharmacologic corticoids in relation to the clinical syndrome of septic shock provides evidence that corticosteroids improve human survival rate. This evidence is borne out by Schumer's controlled retrospective and prospective double-blind study. Aggressive therapy must begin at the onset of shock; pharmacologic doses of steroids are essential. The three steroids most frequently investigated are methylprednisolone, hydrocortisone, and dexamethasone. To date, a clear advantage of one agent over the other has not been demonstrated clinically, although differences in such effects as leukocyte mobilization and neutrophil function are statistically significant in the laboratory. Recent evidence indicates that methylprednisolone has some advantages over dexamethasone in the treatment of shock lung, however, and further studies are necessary to bridge the gaps between laboratory implications and clinical results.
The Pharmacotherapy of Thyroid Storm
Authors: Raber Jack H.
Published: May 2016

A review of thyrotoxic storm is presented. Included are causes, symptomatology, and mortality rates. Special emphasis is placed on the strong correlation between adrenergic blockade and success rates in treating thyrotoxic storm. Pharmacotherapy of the acute storm patient is discussed in detail with respect to agents that (1) decrease production of thyroid hormones; (2) block release of preformed thyroid hormones from the gland; (3) blunt the effects of excess thyroid hormones on the various target organs (e.g., CNS and heart); and (4) serve to decrease the metabolic strain on all organ systems caused by thyrotoxic storm.
Acetazolamide-Induced Metabolic Acidosis
Authors: Jim Lucia K. , Gee Joseph P. , Wolfman David
Published: May 2016

A case describing possible acetazolamide-induced metabolic acidosis is reported. The importance of recognizing unusual complaints of abdominal pain, anorexia, headache, and sensorium changes in elderly patients receiving acetazolamide is emphasized. Differential diagnosis of metabolic acidosis is also discussed.
Avoidance of Adverse Effects during Chronic Therapy with Theophylline
Authors: Hendeles Leslie , Weinberger Miles
Published: May 2016

Recent definition of the pharmacodynamics and pharmacokinetic characteristics of theophylline and readily available, specific assays have increased the therapeutic benefits of this drug while decreasing the risk of toxicity. Once familiarity is achieved with the various factors that can alter clearance, such as age, smoking habits, physiological abnormalities, and concurrent drug therapy, an initial dosage can be appropriately individualized. Careful product selection, the slow progressive titration of dose over nine days, and the accurate measurement and interpretation of serum theophylline concentration can prevent adverse effects and interactions. However, long-term therapy with theophylline should probably be avoided when other drugs are available for patients with cor pulmonale, liver dysfunction, congestive heart failure, migraine headaches, and seizure disorders.
Determining Phenytoin Dosage with the Use of a Programmable Calculator
Authors: King William , Kaul Alan F.
Published: May 2016

Phenytoin often can be a difficult drug to dose because of its nonlinear elimination kinetics. Interpatient variability of the hydroxylating enzyme further complicates matters. Several methods have been proposed to aid the practitioner in predicting the correct dose to give a patient. Ludden et al. have proposed a method based on the patient's plasma concentration to dose response. This method is somewhat complicated. The authors present two programs for the programmable calculator based on this method.
Counseling the Hearing-Impaired Older Adult
Authors: Lamy Peter P. , Chermak Gail , Jinks Martin
Published: May 2016

Older adults use more prescription medication than any other segment of our society. They consume about 1/4 of all prescription drugs while comprising only 1/10 of the general population.23 This widespread use of medications, while perhaps increasing longevity and improving the quality of life of older adults, also subjects these patients to a wide array of adverse drug reactions which often may be more serious than the illness for which the medication was prescribed. It has been documented that the risk of adverse reactions nearly doubles in the aged compared to younger adults.21 One report found that 60 percent of an elderly outpatient population made errors in self-medication, and more than 25 percent of these committed potentially serious errors.25 An alarming number of older adults are admitted to hospitals as a direct result of preventable drug reactions.26

As noted earlier, presbycusis afflicts nearly 14 million (60 percent) of the individuals over age 65, and these older adults are particularly vulnerable to drug-use problems. A significant number have difficulty taking their medication in the manner intended by the physician because of inadequate instruction and poor comprehension of directions resulting from hearing-impairment. An understanding of the social and medical implications of hearing impairment in the older adult and the use of the basic communication techniques described in this paper will assist the pharmacist to improve his counseling efforts in the hearing-impaired older adult. ≃
Frozen Storage and Microwave Thawing of Parenteral Nutrition Solutions in Plastic Containers
Authors: Ausman R.K. , Kerkhof K. , Holmes C.J. , Cantwell R. , Kundsin R.B. , Walter C.W.
Published: May 2016

Amino acid-dextrose solutions for parenteral nutrition in flexible plastic containers can be stored for prolonged periods at — 20°C and then thawed immediately before anticipated use in a microwave oven. The purpose of this study was to demonstrate that neither exposure to low temperatures nor microwave energy affects the integrity of the solution components. We have demonstrated that this concept can be applied to the development of an efficient, pharmacy-based parenteral nutrition admixture program, unfettered by constraints of production limitations and the requirements for infusion of admixtures within 24 hours of preparation. Some cost savings may accrue.
Dilemmas in Evaluating Health Care and Clinical Programs
Authors: McGhan William F.
Published: May 2016

This article discusses some of the dilemmas in evaluation research that are commonly encountered in evaluating pharmacy and health care programs. Emphasis is on the difference between decision-oriented evaluation and hypothesis-testing research. Deficiencies, abuses, and pitfalls are discussed along with rationalizations often generated by negative findings. Disclosure of the problems that arise should make the path to quality evaluations less perilous.
Update on the Treatment of Bacterial Urinary Tract Infections
Authors: Massoud Neil
Published: May 2016

The treatment of urinary tract infections (UTIs) has become a complex problem for the clinical practitioner. An understanding of the pharmacology, pharmacokinetics, and in vivo biological activity of antimicrobial agents is needed, as is an understanding of the variables that may influence patient compliance with medication regimens. Although UTIs are usually treated for 10 to 14 days, shorter treatment schedules of seven to ten days or even single-dose regimens are possible. Guidelines for the treatment of UTIs are presented along with suggestions for increased patient compliance.
Preceptors' Views of Community Pharmacy Clerkships: A National Survey
Authors: Tannenbaum Renee P. , Sohn Catherine A. , Gerbino Philip P. , Gans John A.
Published: May 2016

A survey was administered to a random sample of community pharmacy practitioners who participate as preceptors in clerkship programs for colleges of pharmacy throughout the country. The purpose of this survey was to determine (1) in what ways, if any, students have affected the preceptors' practices; (2) whether the students served as a source of continuing education to the preceptors; (3) whether the preceptors identified areas of students' strengths/deficiencies; and (4) roles of colleges of pharmacy and pharmacy associations in providing continuing education programs for pharmacists.

Results of this survey are discussed. Data are cross-tabulated for types of pharmacy services provided, years in practice, length of clerkship rotations, and other essential demographic information needed for evaluation.

Based on responses, recommendations are made that will provide guidance to colleges of pharmacy, pharmaceutical associations, and practitioners currently involved or those who are considering involvement in clerkship programs.
The Effect of Inservice Education Provided by Consultant Pharmacists on the Behavior of Nurses in Long-Term Care Facilities
Authors: Lamy Peter P. , Westfall Lawrence K. , Speedie Stuart M.
Published: May 2016

The objectives of the study were to assess whether an in-service education program for nurses in long-term care facilities was effective in increasing the nurses' knowledge of drugs and whether the increased knowledge affected nurses' behavior regarding drug therapy monitoring.

The four-phase study was conducted in two study homes and two control homes and consisted of pre-tests, inservice, post-tests, and a three-month evaluation period.

The results indicate that nurses in the study homes demonstrated a statistically significant increase in drug knowledge, and this was reflected in an objective change in behavior to more appropriate monitoring of drug therapy.

It may be concluded that intensive inservice education programs are an effective method for inducing behavioral changes in nurses working in long-term care settings. These changes can improve the nurses' ability to monitor and promote safe and efficacious drug therapy in long-term care facilities.
Needs Assessment: Selecting Goals for a Clinical Program
Authors: Kosecoff Jacqueline , Fink Arlene
Published: May 2016

The application of a needs assessment technique to create a family practice program and residency in a major teaching hospital is described. The technique relies on selecting program objectives by providing health services that are considered important by the community, feasible to obtain within its resources, and not currently available.
Computer-Simulated Conversion from Intravenous to Sustained-Release Oral Theophylline
Authors: Iafrate R. Peter , Gotz Vincent P. , Robinson J. Daniel , Lupkiewicz Stefan M.
Published: May 2016

A computer equipped with a pharmacokinetic program was used to theoretically determine the proper time to administer the first dose of a commonly prescribed, sustained-release oral theophylline product (Theo-Dur) in patients maintained on a continuous intravenous aminophylline infusion. Four conversion methods were tested. They included giving the first oral dose (1) immediately upon discontinuation of the iv infusion, (2) two hours after discontinuing the iv infusion, (3) four hours after discontinuing the iv infusion, and (4) two hours before discontinuing the iv infusion. Each of the four methods was simulated in three groups of patients: Smokers, nonsmokers, and patients with cirrhosis. Results showed that, in most situations, giving the first oral dose immediately upon discontinuation of the intravenous infusion provided minimal deviation from eventual steady-state levels. In addition, this computer simulation suggests that the initial 12-hour maintenance dose recommended by the FDA may result in toxicity in certain patient groups.
Investigation of a Dosage Regimen for Intravenous Theophylline
Authors: Hughey Marshall C. , Yost Richard L. , Robinson J. Daniel , Harman Eloise M.
Published: May 2016

A study was designed to evaluate the validity of the dosage guidelines for theophylline recommended by Hendeles and Weinberger. A total of seven asthmatic smokers and non-smokers were entered and studied. Theophylline serum concentrations were determined prior to the start of therapy and at intervals following initiation of an infusion. The mean theophylline concentration attained for all subjects was 10 μg/ml, however, five of the six patients completing the study did not achieve the predicted serum theophylline concentration. Further study of higher dosage designed to achieve a concentration of 12 μg/ml is suggested.
Drugs and Liver Disease: A Tabular Compilation of Drugs and the Histopathological Changes That Can Occur in the Liver
Authors: Tucker Robert A.
Published: May 2016

A compilation of drugs and the histopathological changes that can occur in the liver is presented. The purpose of this review is to provide the reader with a comprehensive and reliable source of information on various drugs that have been documented by liver biopsy to cause hepatocellular damage. The morphologic terms used in the tables have been chosen based on past publications dealing with this subject. This review is intended as a concise guide to aid in the identification of drug-induced liver diseases.
Interactions of Isoniazid with Foods
Authors: Hauser Mark J. , Baier Horst
Published: May 2016

We reviewed reactions previously reported in patients treated with isoniazid, who ate certain fish and cheeses. We observed similar reactions in two patients after they ingested cheese and wine. Isoniazid is an inhibitor of both monoamine and diamine oxidases, which contribute to the metabolism of histamine that may be present in some fish and cheeses. Monoamine oxidase also acts in the metabolism of tyramine, present in some cheeses and wines. Reactions reported after eating fish or cheese, in patients treated with isoniazid, are similar in that both are characterized by headache, palpitations, skin flushing, nausea, vomiting, and pruritus. Reactions after fish have not been associated with increased blood pressure, whereas those following cheese ingestion frequently result in modest increases in blood pressure. Patients treated with isoniazid should be alerted to the possibility of reactions after eating certain foods.
A Review of Possible Toxicity of DI-2-Ethylhexylphthalate (DEHP) in Plastic Intravenous Containers: Effects on Reproduction
Authors: Kaul Alan F. , Souney Paul F. , Osathanondh Rapin
Published: May 2016

Many containers for intravenous solutions are made with plasticized polyvinyl chloride, the common form of which is di-2-ethylhexylphthalate (DEHP). Extraction of DEHP into blood and plasma stored in such plastic containers can occur, and harmful effects of DEHP in the human body consequently have been suggested. Reports on toxicity of DEHP in animals during pregnancy and the developmental period are critically reviewed.
Postoperative Peritonitis Due to Saccharomyces Cerivisiae—Treated with Ketoconazole
Authors: Canafax Daniel M. , Mann Henry J. , Dougherty Steve H.
Published: May 2016

A case of postoperative peritonitis caused by Saccharomyces cerivisiae and successfully treated with ketoconazole is reported. S. cerivisiae was grown, in culture, from the peritoneal cavity of a patient with postoperative fever and leukocytosis treated with broad-spectrum antibiotics. Possible etiologies of the peritonitis are discussed.
Amitriptyline-Related Peripheral Neuropathy Relieved during Pyridoxine Hydrochloride Administration
Authors: Meadows Gary G. , Huff Marvin R. , Fredericks Sally
Published: May 2016

AMITRIPTYLINE, a tricyclic antidepressant, is widely used to treat depression.1,2 Several reports indicate that this drug can induce symptoms of peripheral neuropathy.3–7 In the following case, peripheral paresthesias developed during amitriptyline therapy and were controlled by administration of oral pyridoxine hydrochloride (HCl).
Pharmacologic Management of Subarachnoid Hemorrhage
Authors: Quandt Christine M. , de los Reyes R.A. , Diaz Fernando G. , Ausman James I.
Published: May 2016

Subarachnoid hemorrhage, following rupture of an intracranial aneurysm, affects about 25 000 people in the U.S. each year. Less than half the patients who survive until hospital admission have an overall favorable outcome. This high morbidity and mortality rate is a result of serious complications following the initial subarachnoid hemorrhage, the most significant of these being rebleeding and cerebral ischemia secondary to vasospasm. While surgical clipping of the aneurysm is the most definitive therapy, this procedure may be postponed for a week or two after the initial hemorrhage, depending on the patient's clinical condition. Pharmacological therapy is a critical part of the preoperative care of these patients and of the postoperative management of complications. This article discusses the syndromes of rebleeding and vasospasm and reviews the current pharmacologic therapy for each.
Metoclopramide in the Treatment of an Infant with Gastroesophageal Hypomotility
Authors: Ponte Charles D.
Published: May 2016

Pediatric patients with organic and congenital gastrointestinal disorders, including gastroesophageal reflux, may benefit from metoclopramide therapy. In addition, the weight gain, secondary to metoclopramide therapy, as experienced by the patient in this report, may enhance patient tolerance to corrective surgical procedures. Further research is necessary to define proper dosage recommendations and to determine those patients who will be successfully treated.
Treatment of Hypercalcemia
Authors: Elliott Gary T. , McKenzie Michael W.
Published: May 2016

The indications, effectiveness, and adverse effects of the numerous treatment modalities for hypercalcemia are presented. Results of a retrospective chart review of 72 admissions (53 patients) for hypercalcemia-related diseases are presented to emphasize the therapeutic principles that should be applied in the management of these patients. Hydration, forced diuresis, oral phosphates, and glucocorticosteroid drugs are common therapeutic approaches. Combination therapy with glucocorticosteroid drugs, oral phosphates, and forced diuresis is utilized to take advantage of multiple mechanisms of action. Outpatient therapy for hypercalcemia consists primarily of glucocorticosteroid agents and oral phosphates. Most patients are treated if the serum calcium level is ≥ 12 mg/dL. An algorithm is presented to assist the clinician in selecting the most efficacious treatment plan.
Some Consequences of Drug Choice and Dosage Regimen for Patients with Impaired Kidney Function
Authors: Vree Tom B. , Hekster Chiel A. , van Dalen Roelof
Published: May 2016

The object of this article is to discuss difficulties in extrapolating the performances of a drug for which the kinetic parameters are derived in healthy volunteers, to patients with severely impaired kidney function. The theoretical background of some actual or probable background is given, and a possible solution for these problems is offered, that is, choosing another drug from the same drug group.

In patients without kidney function, metabolism is the only pathway of elimination. When the elimination of the metabolite formed occurs by means of renal excretion only, this metabolite accumulates in patients with impaired or absent kidney function.

When a metabolic pathway of the parent drug is part of a metabolic equilibrium, the metabolic return reaction results in an “apparent parent compound,” with a half-life identical to that of the accumulated metabolite. In this way, the concentration of the “apparent” parent compound increases and the half-life of the sum of parent and “apparent” parent drug will change.

Examples of this drug behavior are given for sulfamethoxazole, sulfametrole, sulfamethizole, procainamide, and N4-acetylprocainamide.