bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive and Aggressive Reactions of Male Dating Violence Perpetrators to Anger Arousal
Authors: Eckhardt Christopher I. , Crane Cory A.
Published: July 2014

In the current study, 20 dating violent and 27 non-violent college males provided verbal articulations and self-report data regarding cognitive biases, change in affect, and aggressive reactions following anger induction through the articulated thoughts in simulated situations paradigm. Violent, relative to non-violent, males articulated more cognitive biases and verbally aggressive statements during provocation. These same relationships did not hold for a retrospective self-report measure. Greater cognitive biases and aggressive articulations reliably distinguished between violent and non-violent males in the current study. Results suggest that assessing cognitive and affective content “in the heat of the moment” may be a more sensitive indicator of dating violence than retrospective self-reports.
Molecular, biological, and antigenic characterization of a Border disease virus isolated from a pig during classical swine fever surveillance in Japan
Authors: Nagai Makoto , Aoki Hiroshi , Sakoda Yoshihiro , Kozasa Takashi , Tominaga-Teshima Kaho , Mine Junki , Abe Yuri , Tamura Tomokazu , Kobayashi Tsubasa , Nishine Kaoru , Tateishi Kentaro , Suzuki Yudai , Fukuhara Mai , Ohmori Keitaro , Todaka Reiko , Katayama Kazuhiko , Mizutani Tetsuya , Nakamura Shigeyuki , Kida Hiroshi , Shirai Junsuke
Published: July 2014

In the current study, molecular, biological, and antigenic analyses were performed to characterize Border disease virus (BDV) strain FNK2012-1 isolated from a pig in 2012 in Japan. The complete genome comprises 12,327 nucleotides (nt), including a large open reading frame of 11,685 nt. Phylogenetic analysis revealed that FNK2012-1 was clustered into BDV genotype 1 with ovine strains. FNK2012-1 grew in porcine, bovine, and ovine primary cells and cell lines, but grew better in bovine and ovine cells than in porcine cells. Specific pathogen–free pigs inoculated with FNK2012-1 did not show any clinical signs. Noninoculated contact control pigs also did not show clinical signs and did not seroconvert. The results suggest that FNK2012-1 may be of ruminant origin and is poorly adapted to pigs. Such observations can provide important insights into evidence for infection and transmission of BDV, which may be of ruminant origin, among pigs.
The Exploration of Acculturation and Health Among Immigrants From Non-Eastern Cultures
Authors: Kim Junhyoung , Heo Jinmoo , Park Se-Hyuk
Published: July 2014

Literature on acculturation has been mainly focused on how acculturation influences the perception of health and well-being among immigrants from non-Western cultures. Conversely, we sought to explore immigration experiences associated with health and well-being among immigrants from non-Eastern cultures during their acculturation process. With a sample of 9 participants, we identified two major themes as outcomes of acculturation: psychological well-being and social benefits. We found that during acculturation, Western immigrants improved their sense of happiness, experienced reduced stress, and discovered meaning through activities, and that overall, acculturation facilitated personal growth. In addition, they developed a sense of cross-group friendships with Korean people and facilitated group cohesion within their own ethnic group. Further implications and future research avenues are discussed.
Global Concerns and Local Realities
Authors: Walton Elizabeth
Published: July 2014

Inclusive education is a global phenomenon expressed differently in various countries, and different contextual realities support or constrain the process of making education more inclusive. This column reports on an international conference on inclusive education in Johannesburg, South Africa, which provided the opportunity for delegates to share research on dismantling educational exclusion and enabling inclusion. An analysis of conference abstracts reveals five concerns in making education inclusive that are shared across the developing and developed world. These are: students who experience difficulties, listening to understand inclusion and exclusion, teacher education for inclusive education, research issues in inclusive education, and systemwide implementation and evaluation.
Targeted Management Tips to Enhance the Effectiveness of Tier 2, Guided Reading Instruction
Authors: Marchand-Martella Nancy E. , Martella Ronald C. , Lambert M. Charles
Published: July 2014

Guided reading is a popular approach to teaching reading in today’s schools. With the increase of schools and districts implementing response-to-intervention programs, guided reading can be easily enhanced to provide additional supports for students at risk for school failure who exhibit learning and behavioral challenges. This column offers teachers targeted behavior management tips to use before, during, and after more-focused Tier 2 guided reading instruction.
Designing adaptive humanoid robots through the FARSA open-source framework
Authors: Massera Gianluca , Ferrauto Tomassino , Gigliotta Onofrio , Nolfi Stefano
Published: July 2014

We introduce FARSA, an open-source Framework for Autonomous Robotics Simulation and Analysis, that allows us to easily set up and carry on adaptive experiments involving complex robot/environmental models. Moreover, we show how a simulated iCub robot can be trained, through an evolutionary algorithm, to display reaching and integrated reaching and grasping behaviours. The results demonstrate how the use of an implicit selection criterion, estimating the extent to which the robot is able to produce the expected outcome without specifying the manner through which the action should be realized, is sufficient to develop the required capabilities despite the complexity of the robot and of the task.
Antifibrinolytic Agents and Desmopressin as Hemostatic Agents in Cardiac Surgery
Authors: Erstad Brian L
Published: July 2014

OBJECTIVE:

To review the use of systemic hemostatic medications for reducing bleeding and transfusion requirements with cardiac surgery.

DATA SOURCES:

Articles were obtained through computerized searches involving MEDLINE (from 1966 to September 2000). Additionally, several textbooks containing information on the diagnosis and management of bleeding associated with cardiac surgery were reviewed. The bibliographies of retrieved publications and textbooks were reviewed for additional references.

STUDY SELECTION:

Due to the large number of randomized investigations involving systemic hemostatic medications for reducing bleeding associated with cardiac surgery, the article selection process focused on recent randomized controlled trials, meta-analyses, and pharmacoeconomic evaluations.

DATA EXTRACTION:

The primary outcomes extracted from the literature were blood loss and associated transfusion requirements, although other outcome measures such as mortality were extracted when available.

DATA SYNTHESIS:

Although the majority of investigations for reducing cardiac bleeding and transfusion requirements have involved aprotinin, evidence from recent meta-analyses and randomized trials indicates that the synthetic antifibrinolytic agents, aminocaproic acid and tranexamic acid, have similar clinical efficacy. Additionally, aminocaproic acid (and to a lesser extent tranexamic acid) is much less costly. More comparative information of hemostatic agents is needed relative to other outcomes (e.g., reoperation rates, myocardial infarction, stroke). There is insufficient evidence to recommend the use of desmopressin for reducing bleeding and transfusion requirements in cardiac surgery, although certain subsets of patients may benefit from its use.

CONCLUSIONS:

Of the medications that have been used to reduce bleeding and transfusion requirements with cardiac surgery, the antifibrinolytic agents have the best evidence supporting their use. Aminocaproic acid is the least costly therapy based on medication costs and transfusion requirements.
Plasma Renin Activity Testing to Guide Triple Antirenin System Drug Therapy in a Patient With Difficult-to-Treat Hypertension
Authors: Shah Sachil , Coakley Christina , Hough Augustus , Parra David
Published: July 2014

Objective: To report a case of difficult-to-treat hypertension ultimately managed with triple antirenin (anti-R) therapy using plasma renin activity (PRA) to guide medication selection. Case Summary: A 66-year-old white man was referred to the cardiology pharmacotherapy clinic for difficult-to-treat hypertension. His initial office blood pressure (BP) was 152/71 mm Hg on diltiazem and chlorthalidone. After a series of medication adjustments based on serial PRA measurements, the patient achieved his target BP with a regimen that included 3 anti-R angiotensin system medications: carvedilol, valsartan, and aliskiren. Discussion: Despite continued progress in the understanding and pharmacological therapy for hypertension, uncontrolled hypertension remains a major problem. The most common strategy to control hypertension is the stepped-care approach, with progressive addition of medications to eventually reach the BP goal. An alternative approach includes the use of PRA measurements to guide both the addition and removal of drugs in an attempt to effectively control BP. At times, this has the potential to result in a drug regimen that is incongruous with current guidelines and practice recommendations. However, if this results in more effective BP control with the same, or fewer, number of medications, it may represent a reasonable alternative. Conclusion: This case report illustrates a real-world application of PRA-guided therapeutics in a patient with difficult-to-treat hypertension. It highlights how a personalized approach can lead to BP control with a more streamlined regimen than would likely result if a stepped-care approach was used.
Proactive Pharmaceutical Care Interventions Improve Patients’ Adherence to Lipid-Lowering Medication
Authors: Stuurman-Bieze Ada G. G. , Hiddink Eric G. , van Boven Job F. M. , Vegter Stefan
Published: July 2014

Bachground: Lipid-lowering drugs are effective preventive medication for patients at risk of cardiovascular complications. However, medication adherence is suboptimal, thereby decreasing therapy effectiveness. Pharmaceutical care interventions may increase therapy adherence. Objective: To assess the effect of a proactive pharmaceutical care intervention program, Medication Monitoring and Optimization (MeMO), on therapy discontinuation and adherence with lipid-lowering drugs as well as patients’ satisfaction with the intervention program. Methods: This prospective intervention study included 1002 patients initiating lipid-lowering drug therapy from 9 Dutch community pharmacies. In the intervention group (n = 500), the MeMO program was used, comprising continuous monitoring of patients’ adherence to lipid-lowering drugs and personal counseling with nonadherent patients. The intervention group was compared with a historical reference group (n = 502) receiving usual care. Outcomes were therapy discontinuation and adherence. Results: Discontinuation rates with lipid lowering drugs in the first year after drug initiation were 13.6% for the intervention group and 25.9% in the usual care group; continued but non-adherent use was 3.2% and 7.6% in these groups. Patients in the MeMO program had a decreased risk to discontinue medication of 51% (95% confidence interval: 34%-63%). Results were not affected by potential confounders. Patient satisfaction with MeMO was very high; one quarter of patients mentioned that they only received information about their medication from their pharmacy. Conclusions: Improving adherence to lipid lowering drugs can be achieved by a proactive pharmaceutical care program. Pharmacists can contribute to optimal use of chronic medication, which is likely to reduce healthcare costs.
Avanafil for Erectile Dysfunction
Authors: Kyle Jeffrey A. , Brown Dana A. , Hill Jerame K.
Published: July 2014

Objective: To review the pharmacology, pharmacokinetics, safety, and efficacy of avanafil and evaluate relevant clinical trial data. Data Sources: A MEDLINE, International Pharmaceutical Abstracts, ClinicalTrials.gov, and Google Scholar searches (1966 to July 2013) were conducted using the key words: avanafil, erectile dysfunction, and phosphodiesterase type 5 (PDE5) inhibitor. Study Selection and Data Extraction: Articles evaluating avanafil for erectile dysfunction (ED) published in English and using human subjects were selected. Five clinical trials were identified. References cited in identified articles were used for additional citations. Data Synthesis: Avanafil is a highly selective PDE5 inhibitor that is a competitive antagonist of cyclic guanosine monophosphate. Specifically, avanafil has a high ratio of inhibiting PDE5 as compared with other PDE subtypes allowing for the drug to be used for ED while minimizing adverse effects. Absorption occurs quickly following oral administration with a median Tmax of 30 to 45 minutes and a terminal elimination half-life of 5 hours. Additionally, it is predominantly metabolized by cytochrome P450 3A4. As such, avanafil should not be co-administered with strong cytochrome P450 3A4 inhibitors. Dosage adjustments are not warranted based on renal function, hepatic function, age or gender. Five clinical trials suggest that avanafil 100 and 200 mg doses are effective in improving the Sexual Encounter Profile and the Erectile Function Domain scores among men as part of the International Index of Erectile Function. A network meta-analysis comparing the PDE5 inhibitors revealed avanafil was less effective on Global Assessment Questionnaire question 1 while safety data indicated no major differences among the different PDE5 inhibitors. The most common adverse effects reported from the clinical trials associated with avanafil were headache, flushing, nasal congestion, nasopharyngitis, sinusitis, and dyspepsia. Conclusions: Avanafil is a potent PDE5 inhibitor and is an effective treatment option for ED.
A Comparison of the Risk of QT Prolongation Among SSRIs
Authors: Funk Kylee A. , Bostwick Jolene R.
Published: July 2014

Objective: To report QT prolongation potential in selective serotonin reuptake inhibitors (SSRIs) in order to advise clinicians on safe use of SSRIs other than citalopram in light of citalopram warnings. Data Sources: Primary literature and case reports were identified through a systematic search. Data from drug manufacturers, package inserts, and the ArizonaCERT database were also utilized. Study Selection and Data Extraction: English-language studies and case reports were included. Data Synthesis: Studies demonstrate possible dose-related clinically significant QT prolongation with escitalopram. Fluoxetine, fluvoxamine, and sertraline at traditional doses demonstrate a lack of clinically significant increases in QTc in the majority of studies. Further, paroxetine monotherapy shows a lack of clinically significant QTc prolongation in all studies. However, case reports or reporting tools still link these SSRIs with QTc prolongation. Fluoxetine, escitalopram, and sertraline used in post–acute coronary syndrome patients did not demonstrate risk of QTc prolongation. Conclusion: For clinicians who choose not to use citalopram due to recent Food and Drug Administration (FDA) recommendations, other antidepressants within this class may be considered. When citalopram is not utilized based on risk factors for TdP, use of escitalopram is not likely the safest alternative. Based on current literature, fluoxetine, fluvoxamine, and sertraline appear to have similar, low risk for QT prolongation, and paroxetine appears to have the lowest risk. However, there are significant limitations in interpreting the studies, including varying definitions of significant QT prolongation. Therefore, choice of an alternative SSRI should be based on individual risk factors for arrhythmias and other patient-specific factors.
Mortality Following Rasburicase-Induced Methemoglobinemia
Authors: Bucklin Mason H. , Groth Christine M.
Published: July 2014

Objective: To report a case of mortality following rasburicase-induced methemoglobinemia. Case Summary: A 62-year-old African American male with chronic lymphocytic leukemia and small lymphocytic lymphoma was admitted for tumor lysis syndrome and renal failure. He was treated with 2 doses of rasburicase, subsequently developed methemoglobinemia, and required intubation, multiple packed red blood cell (PRBC) transfusions, and 2 doses of methylene blue. A screen for glucose-6 phosphate dehydrogenase (G6PD) deficiency was negative. His course was complicated by hemolytic anemia, nosocomial pneumonia, Clostridium difficile infection, and septic shock. His methemoglobin concentrations normalized over several days; however, the patient eventually died on hospital day 16. An objective causality assessment revealed that the adverse drug reaction was probable. Discussion: Our case was similar to previously published cases, except that our patient died and his G6PD screen was negative. Although it was negative, it is likely that this was a false negative result because this blood was drawn shortly after PRBC transfusions and during active hemolysis. Both these are likely to cause false-negative results. Conclusions: Methemoglobinemia is a rare adverse effect associated with the use of rasburicase and occurs most often in patients with G6PD deficiency. G6PD testing should not be ordered during active hemolysis or after blood transfusion because this may lead to false-negative results. Methylene blue should not be used as an antidote because it may worsen hemolytic anemia in patients with G6PD deficiency.
Association of Polypharmacy and Statin New-User Adherence in a Veterans Health Administration Population
Authors: Watanabe Jonathan H. , Bounthavong Mark , Chen Timothy , Ney John P.
Published: July 2014

Background: The relationship between multiple medication consumption and medication adherence is not well understood. Objective: To determine the association between the number of active medications on the patient medication profile at baseline and adherence in new users of statins. Methods: This was a retrospective cohort study of new users of statin medications from the Veterans Health Administration. We explored the correlation between the number of baseline medications and adherence, grouping patients by number of active medications on the study index date via Cochran-Armitage trend test and multiple linear regression. The adherence metric calculated for each patient was the medication possession ratio (MPR). Adherence was defined as achieving a 0.8 MPR or greater in primary analysis and a 0.9 MPR or greater in the secondary analysis. Results: There was a statistically significant trend of increasing proportion of adherent participants as baseline medication count grew (P value < .001). The regression further demonstrated that statin MPR was increased by 0.04, 0.07, 0.10, and 0.14 for the 6 to 10 medication count, 11 to 15 medication count, 16 to 20 medication count, and >20 medication count groups, respectively, in comparison with the reference 1 to 5 medication count group (P < .001 for all comparisons). An MPR threshold of 0.9 provided consistent evidence of improved adherence as number of medications increased (P < .001). Conclusions: Increased medication count at baseline was associated with improved adherence for new users of statins.
Feasibility of a Pharmacy-Based Influenza Immunization Program in an Academic Emergency Department
Authors: Cohen Victor , Jellinek-Cohen Samantha P. , Likourezos Antonios , Lum Diane , Zimmerman David E. , Willner Marc A. , Rose Jonathan , Marshall John P.
Published: July 2014

Background: From September 2002 to August 2010, 13 patients who were discharged from the emergency department (ED) were immunized against influenza. This correlates with a time when pharmacists were not permitted to vaccinate patients in New York. Objective: The objectives of this study were to determine the feasibility of a pharmacist-based influenza vaccination program in the ED, assess patients’ willingness to be vaccinated by a pharmacist, and identify reasons for declination. Methods: This was a cross-sectional study involving English-speaking patients older than 18 years. The pharmacist vaccinated patients, if they consented. Patients who refused to be vaccinated were asked why they did not want to receive the vaccine and their perception of pharmacists vaccinating patients in the ED. The percentage of patients vaccinated; time elements associated with the process of screening, counseling, and vaccinating; and the type and frequency of adverse events were recorded. Results: Of 149 patients, 62 patients (41%) agreed to receive the vaccine, a 4-fold increase from the previous 8 years. The median screening and vaccination time was 8 minutes. Of those not receiving a vaccine in the ED, 74% were willing to receive the influenza vaccine from a pharmacist, and 78% were willing to receive the vaccine in the ED. The most common reason for refusal was perception of low self-risk (43.9%). No adverse events were reported. Conclusions: A pharmacist-based influenza immunization program is feasible in the ED and has the potential to successfully and safely increase the percentage of adult patients receiving the vaccine.
Daptomycin Dosing Strategies in Patients Receiving Thrice-Weekly Intermittent Hemodialysis
Authors: Haselden Molly , Leach Molly , Bohm Nicole
Published: July 2014

Objective: To determine the optimal dosing regimen of daptomycin in patients receiving thrice-weekly hemodialysis. Data Sources: Literature was accessed via PubMed using the terms daptomycin and hemodialysis through July 2013. Reference citations from publications identified were reviewed. Study Selection and Data Extraction: English language articles meeting the search criteria were evaluated. Studies were included if they addressed either thrice-weekly or intradialytic daptomycin administration. Data Synthesis: Daptomycin is approved for the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus and other Gram-positive organisms. Rapid bactericidal activity and limited potential for drug interactions make daptomycin an attractive agent. However, the daptomycin prescribing information recommends dosing every 48 hours in patients receiving hemodialysis, which results in dyssynchrony of dosing and dialysis sessions every other week. Studies evaluating a dosing regimen of daptomycin thrice weekly, coinciding with dialysis, indicate that pharmacokinetic and pharmacodynamic parameters are appropriate for therapeutic success. However, to maintain adequate serum drug concentrations throughout the 72-hour interdialytic period, an additional 50% of the dose should be provided to account for the longer interval. Intradialytic dosing, with the administration of daptomycin infusion beginning during the final 30 minutes of dialysis, may also require a dose increase. Limited clinical outcomes data have been reported, but no significant safety concerns have been identified. Conclusions: Administration of daptomycin doses thrice weekly on hemodialysis days appears to be both safe and reasonable. Doses should be increased preceding the 72-hour interdialytic period or if daptomycin is infused during dialysis.
Subcutaneous Versus Intravenous Bortezomib
Authors: Barbee Meagan S. , Harvey R. Donald , Lonial Sagar , Kaufman Jonathan L. , Wilson Nicole M. , McKibbin Trevor , Hutcherson Donald A. , Surati Minal , Valla Kelly , Shah Katherine Sanvidge
Published: July 2014

Background: Subcutaneous bortezomib is noninferior in efficacy to intravenous bortezomib and is associated with a lower incidence of neuropathy in the treatment of multiple myeloma. However, there are no data assessing the effect of subcutaneous bortezomib administration on practice variables or patient preferences. Objective: To quantify the difference in efficiency practice variables and patient preferences regarding subcutaneous versus intravenous bortezomib administration in patients with multiple myeloma. Methods: This study was divided into 2 parts consisting of mutually exclusive patients: a retrospective efficiency study and a survey study. Patients’ medical records were reviewed for efficiency data measures including length of infusion chair time and overall infusion center visit time in patients who received at least 6 doses of bortezomib. Patients who received at least 1 dose each of subcutaneous and intravenous administration were surveyed regarding preference, satisfaction, injection site reactions, and quality of life measures. A database was used to identify eligible patients for each portion of the study. Results: A review of 92 medical records demonstrated a 38% reduction in chair time (143 vs 89 minutes; p < 0.001) and a 27% reduction in infusion center visit time (169 vs 123 minutes; p < 0.001) with subcutaneous versus intravenous administration of bortezomib. Of 47 eligible patients, 60% (28) completed the survey; 68% (19; p = 0.0002) of these patients preferred and were more satisfied with subcutaneous bortezomib administration. The overall incidence of injection site reactions was 39% (11) in the surveyed population and was not significantly different between the 2 preference groups. Limitations of the study include single-center design, small sample size, and nonvalidated survey. Conclusions: Subcutaneous administration of bortezomib is more time efficient for the patient and institution and is preferred by patients compared to intravenous bortezomib.
Does Hospitalization Influence Patients’ Medication Adherence and Community Pharmacists’ Interventions?
Authors: Beloin-Jubinville Bianca , Joly-Mischlich Thomas , Rouleau Emilie Dufort , Noiseux Pascale , Blais Lucie , Forget Amélie , Beauchesne Marie-France
Published: July 2014

Background: Medication adherence reduces disease morbidity. Data regarding changes in a patient’s adherence before and after hospitalization and how this hospitalization influences a pharmacist’s interventions are scarce. Objective: To assess changes in adherence to cardiovascular and respiratory medications in the year preceding and following a hospitalization; explore patients’ perceptions about medication adherence and the pharmacist’s role; and describe pharmacists’ interventions regarding medication adherence. Methods: This cohort study included patients hospitalized for acute coronary syndrome, acute worsening of heart failure, or acute COPD exacerbations. Adherence to cardiovascular and respiratory medications was measured by calculating the proportion of days covered (PDC) from prescription refills. Patient interviews were completed to explore their perceptions about medication adherence and the role of the pharmacist. Community pharmacists were invited to complete an online survey and to participate in focus groups to discuss interventions to improve medication adherence. Results: Medication adherence was assessed for 61 patients; the mean PDC was 69.8% 12 months before hospitalization and 72.4% 12 months following hospitalization. Patients reported that they felt the need to take their medications to prevent worsening of their disease. They were satisfied with current pharmaceutical services. A total of 136 questionnaires completed by pharmacists were analyzed and 9 participants attended the focus groups. Most pharmacists reported monitoring prescription renewals to assess adherence, with no significant influence from the hospitalization itself. The patient’s interest was reported to be an important facilitator, whereas a lack of time and face-to-face interaction with patients who had their medication delivered to their home was reported a main barrier to interventions. This study was limited by a small sample size. Conclusions: Patient medication adherence did not significantly change following hospitalization. Hospitalization does not appear to significantly influence patient and pharmacist behavior towards medication adherence.
Heparin-Induced Hyperkalemia in a Patient Diagnosed with Thyroid Storm
Authors: Cho Roy , LeClaire Michele , Kempainen Robert
Published: July 2014

Objective: To describe a case of heparin-induced hyperkalemia and the role for transtubular potassium gradient (TTKG) to guide fludrocortisone therapy. Case Summary: A 52-year-old white male developed hyperkalemia after receiving intravenous unfractionated heparin (UFH) for atrial fibrillation during thyroid storm. Admission laboratory results were noteworthy for normal potassium levels, undetectable thyroid-stimulating hormone, and mild transaminitis. Treatment for thyroid storm was initiated but UFH was stopped because the international normalized ratio was subsequently found to be elevated. Rising potassium levels developed just 24 hours after UFH discontinuation, without exogenous potassium supplementation, renal dysfunction, or acidosis. A TTKG was low, reflecting a hypoaldosterone state. In addition, the Naranjo probability scale indicated probable medication-associated hyperkalemia. Heparin-induced hyperkalemia (HIH) was suspected and oral fludrocortisone 0.2 mg was given daily alongside serial TTKG measurements. TTKG and hyperkalemia normalized with 2 days of treatment. Discussion: UFH is commonly used; therefore, clinicians must be cautious of hyperkalemia. Although HIH usually resolves after discontinuation of heparin, it may persist despite discontinuation of the drug, as highlighted by this case. In this setting, a TTKG should be determined, which can be used to guide fludrocortisone therapy. Conclusions: HIH can occur despite discontinuation of heparin, and TTKG can be helpful in guiding fludrocortisone treatment in this circumstance.
Phenytoin Removal by Continuous Venovenous Hemofiltration
Authors: Oltrogge Kate M. , Peppard William J. , Saleh Mohammed , Regner Kevin R. , Herrmann David J.
Published: July 2014

Objective: To describe 2 cases of clinically significant phenytoin removal during continuous venovenous hemofiltration (CVVH) and review the relevant literature regarding phenytoin removal by renal replacement modalities. Case Summary: A 64-year-old female with chronic kidney disease and cirrhosis was admitted to the intensive care unit (ICU) with a traumatic subdural hematoma and seizures. The patient received a loading dose of intravenous phenytoin 1000 mg, followed by maintenance intravenous administration of phenytoin 100 mg and levetiracetam 250 mg every 12 hours. CVVH was initiated for acidosis. A 63-year-old male was admitted to the ICU after cardiac surgery complicated by hypotension. CVVH was initiated for fluid overload, and phenytoin was initiated 3 days later for seizures. A loading dose of intravenous phenytoin 2700 mg was administered, followed by maintenance dosing of intravenous phenytoin 150 mg every 8 hours. Concentrations of unbound phenytoin in serum and CVVH effluent samples were measured during concomitant treatment in each patient. In both patients, serum and effluent concentrations of unbound phenytoin fell steadily while they were on CVVH. Clearance of phenytoin by CVVH was calculated, as was the daily removal of phenytoin, as a percentage of total daily phenytoin dosage during each sampling period. Phenytoin clearance by CVVH ranged from 11 to 13 mL/min in these patients. Discussion: The clearance of phenytoin with CVVH in these 2 patients was much higher than the renal clearance of phenytoin reported in healthy volunteers with normal renal function. Previous case reports have demonstrated that only small, clinically insignificant amounts of phenytoin are removed by hemodialysis, and the only published report of phenytoin removal by continuous renal replacement therapy used hemofiltration rates much lower than those used in the 2 cases described here. Conclusions: These cases demonstrate that a substantial amount—approximately 30%—of total daily phenytoin dose may be removed by CVVH, and patients may require higher than expected empiric doses. Phenytoin concentrations should be closely monitored in critically ill patients receiving CVVH.
Sustained Hypotension Following Intravenous Metoclopramide
Authors: Nguyen Tammy T. , Petzel Gimbar Renee M.
Published: July 2014

Objective: To report a case of sustained hypotension associated with the use of intravenous metoclopramide. Case Summary: A 50-year-old woman developed a hypotensive episode lasting approximately 90 minutes after the administration intravenous metoclopramide for the treatment of a migraine. The patient presented to the emergency department after she woke up with a severe headache that was much worse than her normal migraine headaches. Her past medical history included migraines, diabetes type 2, hypertension, and hyperlipidemia. Fifteen minutes after the administration of intravenous metoclopramide 10 mg, the patient’s systolic blood pressure decreased from 138 to 84 mmHg (a mean arterial pressure decrease of 40.7 mmHg). The patient was given 1 L of intravenous NaCl 0.9% that had minimal effect on blood pressure. The patient did not reapproach her baseline systolic blood pressure until 90 minutes after the metoclopramide administration when it was measured at 138 mmHg. Subsequent contrast tomography of the head was negative and the patient’s headache was successfully treated with butalbital/acetaminophen/caffeine. The patient was discharged home the same day. Discussion: There are few published case reports of metoclopramide-induced hypotension in the current literature. Of those published, all showed transient hypotension with metoclopramide, lasting seconds to minutes. An objective causality assessment for drug-associated adverse drug reaction showed metoclopramide as a probable cause of the patient’s hypotension (Naranjo score of 5). In this case, several indicators of metoclopramide induced hypotension were evident, including the timing of the hypotension after drug administration and the lack of any other possible causes of hypotension. This is the first published case report of sustained hypotension due to intravenous metoclopramide. Conclusion: Intravenous metoclopramide may cause sustained episodes of hypotension.
Icosapent Ethyl for Treatment of Elevated Triglyceride Levels
Authors: Nelson Scott D. , Munger Mark A.
Published: July 2014

Objectives: To review the pharmacology, pharmacokinetics, clinical trial data, adverse effects, and formulary considerations of icosapent ethyl for the treatment of high triglyceride (TG) levels. Data Sources: A literature search with keywords Vascepa, icosapent ethyl, AMR101, and eicosapentaenoic acid of articles up to July 2013, along with the package insert for Vascepa and current guidelines for hypertriglyceridemia. Study Selection/Data Extraction: Two phase-III, placebo-controlled, randomized, double-blind, 12-week clinical trials were included in this review: the MARINE trial and ANCHOR study. The MARINE trial consisted of mainly overweight Caucasian men with fasting TG ≥500 and ≤2000 mg/dL taking 4 g/day icosapent ethyl, 2 g/day, or placebo. The ANCHOR study consisted of mainly overweight Caucasians with type-2 diabetes mellitus on statin therapy, with fasting TG ≥200 and <500 mg/dL taking 4 g/day icosapent ethyl, 2 g/day, or placebo. Data Synthesis: The MARINE trial showed a placebo-corrected median decrease in TG of 33.1% for patients receiving 4 g/day icosapent ethyl, with no significant change in low-density lipoprotein cholesterol (LDL-C) levels. TG was reduced by 19.7% in those taking 2 g/day. The ANCHOR study showed a placebo-corrected decrease in TG of 21.5% with a 6.3% decrease in LDL-C for patients taking 4 g/day icosapent ethyl as add-on to statin therapy. TG was reduced by 10.1% in those taking 2 g/day. The main adverse effect observed was joint pain (2.3%). Conclusions: Icosapent ethyl is effective in reducing TG levels without increasing LDL-C, and has efficacy similar to other TG-lowering therapies with fewer adverse effects or interactions.
Pharmacokinetic and Pharmacodynamic Drug Interactions With New Oral Anticoagulants
Authors: Hellwig Thaddaus , Gulseth Michael
Published: July 2014

Objective: To review pharmacokinetic and pharmacodynamic drug–drug interactions (DDIs) involving new oral anticoagulants for atrial fibrillation. Data Sources: A literature search was conducted via PubMed and the Cochrane database to identify DDI studies using the terms drug interactions, dabigatran, rivaroxaban, and apixaban. Prescribing information and Food and Drug Administration briefing documents were used to supplement published data. Study Selection and Data Extraction: English publications identified on Medline from 2005 up to August 2013 and US prescribing information for approved oral anticoagulants. Data Synthesis: Articles reviewed focused on drugs affecting the permeability glycoprotein (P-gp) efflux transporter protein and/or cytochrome P (CYP) 450 3A4 enzymes, and pharmacodynamic DDIs when drugs are administered concomitantly. Phase I DDI studies have reported pharmacokinetic DDIs mediated by P-gp alone (dabigatran etexilate) or in combination with CYP3A4 enzymes (rivaroxaban and apixaban). Dabigatran etexilate should not be administered with any P-gp inhibitor in patients with severe renal impairment. Briefing documents indicate that rivaroxaban and apixaban should not be used with drugs that are strong inhibitors of both P-gp and CYP3A4. DDI studies involving rifampicin suggest that rivaroxaban and apixaban should be avoided when strong inducers of P-gp and CYP3A4 are used concurrently. Concomitant use of apixaban and strong dual inhibitors of P-gp and CYP3A4 should be avoided or the dose reduced. Five randomized clinical trials report additive effects with rivaroxaban, dabigatran, and apixaban when used concomitantly with antiplatelet agents; bleeding rates have been found to be higher, especially with dual antiplatelet therapy. Conclusions: Awareness of drugs that alter the function of the P-gp efflux transporter protein and CYP3A4 enzymes and provide additive effects should enable prescribers to anticipate and avoid potential DDIs involving the new oral anticoagulants. To this end, briefing documents and prescribing information have applied cautionary measures for individuals treated with these newer anticoagulants.
The Latent Structure of Loneliness
Authors: Shevlin Mark , Murphy Siobhan , Murphy Jamie
Published: July 2014

This study assessed the dimensional structure of the UCLA Loneliness Scale ([UCLA-LS], UCLA-3). Data from the Northern Ireland Young Life and Times Survey (2011), a survey of 1,434 16-year-olds, was used to examine the underlying factor structure of the scale. Confirmatory factor analysis was employed to compare alternative factor analytical models that can inform the scoring of the measure and determine the degree to which different factors provided unique predictive utility. Fit statistics indicated that the best fitting model comprised three correlated factors: Isolation, Related Connectedness, and Collective Connectedness. These findings were consistent with previous findings that identified the multidimensional nature of the UCLA-LS. The study also found evidence that the subscales were differentially associated with psychiatric morbidity as measured by the General Health Questionnaire (GHQ-12) and provides a more reliable and comprehensive framework to assess the clinical significance of loneliness.
Antithrombotic Therapy in Patients With Thrombocytopenic Cancer
Authors: Babilonia Katrina M. , Golightly Larry K. , Gutman Jonathan A. , Hassell Kathryn L. , Kaiser Jeffrey N. , Kiser Tyree H. , Klem Patrick M. , Trujillo Toby C.
Published: July 2014

Background:

Guidelines are discordant concerning management of patients having thrombocytopenia with cancer-associated thrombosis (CAT).

Methods:

Hospitalized adults with CAT and platelets ≤50 × 109 cells/L were managed with dalteparin 100 units/kg subcutaneously once daily. Comparator patients with CAT and platelets >50 × 109 cells/L were managed with dalteparin 200 units/kg/d.

Results:

Outcomes of 35 patients with thrombocytopenia (mean platelet count 26 ± 8.3 × 109 cells/L) and 58 comparator patients (mean platelet count 155 ± 75 × 109 cells/L) were evaluated. In all, 2 (5.7%) patients in the thrombocytopenia group and 1 patient (1.9%) in the comparator group experienced new-onset venous thromboembolism (odds ratio 3.31, 95% confidence interval [CI] 0.29-37.90, P = .556). The incidence of bleeding in patients with thrombocytopenia (8.6%) was similar to that in comparator patients (9.4%; risk ratio 0.94, 95% CI 0.37-2.39, P = .607).

Conclusion:

In hospitalized patients having thrombocytopenia with CAT, reduced-dose low-molecular-weight heparin was generally efficacious.
Accurate method for harmonic responses of non-classically damped systems in the middle frequency range
Authors: Li Li , Hu Yujin , Wang Xuelin
Published: July 2014

This paper is aimed at eliminating the influence of the problem of the harmonic response analysis of non-classically damped systems with lower-higher-modal truncation. Based on the Neumann expansion theorem and the frequency shifting technique, the relationships satisfied by eigensolutions and system matrices are established and an explicit expression on the lower-higher-modal truncation error of harmonic responses can be expressed as a sum of available modes and system matrices. A correction method, which only involves the available modes and system matrices, is then presented to calculate the harmonic responses. The method maintains original-space without having to involve the state-space equation of motion such that it is efficient in computational effort and storage capacity. The method is convergent if and only if all the modes whose resonant frequencies lie within the range of excitation frequencies are available. Finally, a two-stage floating raft isolation system and a sandwich plate are used to to validate the effectiveness of the presented method.
Friction and wear behaviour of induction hardened ISO 42CrMo4 low-alloy steel under reciprocating sliding conditions
Authors: Autay R , Kchaou M , Dammak F
Published: July 2014

Tribological behaviour of induction hardened ISO 42CrMo4 low alloy steel was evaluated under unlubricated sliding conditions. The effect of hardening depth and test conditions on the friction and wear properties was investigated. The tribological tests were carried out on a reciprocating tribometer. Cylinder-on-flat contact configuration was adopted. The results showed that varying the hardened depth, normal load or sliding speed influences the friction coefficient, the friction energy, the wear volume and the wear coefficient. It was found, also, that a change in the wear behaviour occurs when a critical value of normal load is exceeded.
Modern spectacle and American feminism’s disappointing daughters: Writing fantasy echoes in The Portrait of a Lady
Authors: Lamm Kimberly
Published: July 2014

Joan Scott’s ‘fantasy echo’ is deployed to analyse the trope of the mother/daughter relationship in contemporary laments about feminism’s failures, exemplified by Susan Faludi’s ‘American Electra: Feminism’s Ritual Matricide’ (2010). I demonstrate that Faludi’s primary argument – that young feminists do not respect the generations that precede them and therefore halt feminist progress – unreflectively relies upon a feminist maternal fantasy and ignores the prominent role spectacle culture plays in the circumscription of contemporary feminism. Building upon Scott’s attention to literature to interrupt fantasy echoes and their inert visions of how feminism should appear, the article interprets The Portrait of a Lady (1908) through the tools of Scott’s historiography . I argue that Henry James’s novel, focused on an American ‘New Woman’, is an early account of how young women are sold fantasies of feminist freedom through spectacle culture and troubles the assumption that older women only forge benevolent relationships with younger women out of generosity.
Planning of undefined becoming: First encounters of planners beyond the plan
Authors: Boelens Luuk , de Roo Gert
Published: July 2014

Since the 1980s and due to the ongoing complexity and diffuseness of global networked societies, planners have tried to move beyond classic technocratic and/or sociocratic ideas of planning towards new approaches, which address the multiplicity and fuzziness of our perceptions and actions in time and space. Innovative ideas have been developed concerning discursive, collaborative, informal and post-policy planning, as well as relational geography, multi-planar, non-linear and actor-relational approaches. Nonetheless, techno- and sociocratic approaches remain dominant conceptions for much teaching and practice in Europe and elsewhere. This is partly because these innovative contributions of the past 20 or 30 years have been fragmented and isolated. However, they can also be regarded as the beginning of a bigger transition towards what we call a movement of ‘planning of undefined becoming’. In this article, we will sketch a framework in which these innovative ideas about the planner’s perceptions of fuzzy, complex and co-evolving space and time will in some way be interrelated. From this background, we will also critically reflect on some planning experiments in practice inspired reciprocally and incrementally by these ideas, developing applications for practitioners along the way.
School Punishment in the US and England: Divergent Frames and Responses
Authors: Kupchik Aaron , Green David A. , Mowen Thomas J.
Published: July 2014

In an effort to better understand the roots of contemporary school punishment practices, this study compares policy discourse and practice of school punishment and security in the United States and England. American policy discourse is predominantly punitive, harsh punishment strategies are favored, and policy makers have centralized decision-making power outside of the classroom. Contrastingly, English policy discourse about and policy responses to student misbehaviour focus more on reducing social exclusion, improving student behaviour, and returning the locus of control over rule enforcement to teachers. However, despite these substantial differences, suspension and expulsion rates are fairly similar in the US and England. Several hypotheses to explain these findings are offered.
Role of Traditional Nonsteroidal Anti-inflammatory Drugs in Alzheimer’s Disease
Authors: Gupta Prem Prakash , Pandey Rishabh Dev , Jha Diwakar , Shrivastav Vikesh , Kumar Sandeep
Published: July 2014

The role of nonsteroidal anti-inflammatory drugs (NSAIDs) in prevention of Alzheimer’s disease (AD) has been evaluated in many studies. We performed a meta-analysis to summarize the existing evidence on the relation between use of classical NSAIDs and AD. Randomized controlled trials (RCTs) evaluating the role of classical NSAIDs in AD was searched using different search engines. The RCTs in patients who had the degree of AD measured on Mini-Mental State Examination (MMSE) or AD Assessment Scale-Cognitive subscale (ADAS-cog) were included in the study. The RCTs and data (AD scores) were independently assessed by 2 reviewers, and data were included in meta-analysis only after a common consensus was reached. The pooled results from the ADAS-cog and MMSE scores failed to show any difference between the treatment and the placebo groups as opposed to findings from some observational studies. However, in view of heterogeneity of results, there is a need to conduct more RCTs to arrive at confirmatory findings.