bluuebunny/crossref_metadata_2025 huggingface dataset:
Prolonged Use of Modular Enteral Hyperalimentation
Authors: Krey Susanna H. , Crocker Kathleen S. , Porcelli Karen A. , Filibeck Donald J. , Pine Richard W. , O'Brien Gregory F. , Steffee William P.
Published: June 2017

A 55‐year‐old male with squamous cell carcinoma of the left mandible, who was treated with chemotherapy, surgery, and radiation, received enteral hyperalimentation for 83 of his 102‐day hospital stay. The hospital course was complicated by fluid and electrolyte imbalance, sepsis, gastric outlet obstruction, and ileus. A modular system of individual nutrient components was used to prepare enteral formulations during 62 of the 83 days of enteral hyperalimentation. The 10 enteral prescription modifications involved both macro‐ and micronutrients, and could not easily have been prepared using standard enteral products. Enteral formula modifications resulted in extended use of the gastrointestinal tract for nutritional support. Continued use of the gastrointestinal tract instead of the intravenous route resulted in a net savings of $4380. The use of modular enteral hyperalimentation may be indicated when the gastrointestinal tract is functional, but when frequent formula manipulation is desired. Modular enteral hyperalimentation can be adapted easily for use by nutrition support teams in acute care settings.
Effects of Double Cross-Linking Technique on the Enzymatic Degradation and Calcification of Bovine Pericardia
Authors: Vasudev Sindhu C. , Chandy Thomas , Sharma Chandra P. , Mohanty Mira , Umasankar P. R.
Published: June 2017

The strength, resorption rates, and biocompatibility of collagenous biomaterials are profoundly influenced by the method of cross-linking. The in vitro and in vivo calcification and enzymatic degradation of bovine pericardia (BP) after a series of surface modifications were studied as a function of exposure time. Collagenase degradations of modified BP were monitored by scanning electron microscopy and tensile strength measurements. Bovine pericardium was modified by a combination of different tissue fixatives such as glutaraldehyde (GA), carbodiimide (EDC), diisocyanate (HMDIC), and polyethylene glycol (PEG). GA-PEG-EDC-PEG and GA-PEG-HMDIC-PEG combination treated BP retained maximum stability in collagenase digestion compared to GATBP In vitro calcification studies and in vivo rat subcutaneous implantations of modified pericardium have shown substantial reduction in the calcification of double cross-linked BP with PEG modification. Further, the biocompatibility aspects of pericardial tissues were established by platelet adhesion and octane contact angle. It seems that cross-links involving amino and carboxyl residues may provide new ways of controlling biodegradation and calcification.
Effect of Resin Matrix Ratio, Storage Medium, and Time upon the Physical Properties of a Radiopaque Dental Composite
Authors: Deepa C. S. , Krishnan V. Kalliyana
Published: June 2017

Three light curing composite pastes with varying resin matrix ratios [bisphenol A-glycidyl methacrylate (BIS-GMA)/urethane tetramethacrylate (UTMA) 25:75, BIS-GMA/UTMA 50:50, and BIS-GMA/UTMA 75:25 w/w%] were prepared in combination with a radiopaque glass powder and camphorquinone photoinitiator. Cured samples were aged at 37°C in three food simulating media such as citrate buffer (pH 4.0), PBS buffer (pH 7.4), and 75% ethyl alcohol. Samples were withdrawn at specific intervals of 1, 15,30,45, and 60 days and tested for changes in mechanical properties, sorption, and solubility characteristics. Statistical calculations revealed significant changes in compressive strength (CS) for composites depending on the resin matrix ratio and type of medium used for aging. While diametral tensile strength (DTS) was affected adversely in citrate medium for composites with higher urethane content, samples stored in alcohol medium showed deterioration of transverse strength (TS) and microhardness (VMH) for all composites studied. Increase in BIS-GMA content in the resin matrix and storage in alcohol medium resulted in higher sorption and solubility values and lower microhardness.
Market Study: Biomaterials Supply for Permanent Medical Implants
Authors: Aronoff Marvin S.
Published: June 2017

The withdrawal of DuPont as a supplier of key raw materials created a major dislocation in the medical device industry. We studied the present and future impact caused by the market removal of polyethylene terephthalate (PET) yarn ("Dacron®"), polytetrafluoroethylene (PTFE) fiber and resin ("Teflon®"), and polyacetal resin ("Delrin®"). Findings were: 1) Dollar values of the permanent medical implant markets for PET yarn, PTFE fiber and resin, and polyacetal resin are a minute fraction, of their values for their other commercial markets; 2) The implant market value is clearly not commensurate with the liability risk; and 3) The majority of these materials consumed by this market are used in the production of lifesaving, permanent medical implants [e.g., vital blood vessel replacements made from knitted polyester (PET)]. The remainder is used in life-enhancing, permanent implants [e.g., hernia patches made of polyester (PET) fabric].
Melanin-Containing Hydrogel Intraocular Lenses: A Histopathological Study in Animal Eyes
Authors: Chirila Traian V. , Constable Ian J. , Vijayasekaran Sarojini , Ben-Nun Joshua
Published: June 2017

Poly(2-hydroxyethyl methacrylate) hydrogel intraocular lenses, containing adrenochrome-melanin, were manufactured and implanted in animal eyes in order to assess the effect of melanin upon (a) biocompatibility of implants with the eye tissues, and (b) fibrous proliferation of lens epithelium responsible for the opacification of the posterior capsular membrane. An equal number of control lenses were also implanted. The animals were followed up for durations up to two years, and a detailed histopathological examination of the eyes was performed subsequent to their enucleation. The postoperative complications were minor and probably caused by surgical trauma. The study failed to give any indication of the postulated antiproliferative activity of adrenochrome-melanin since minimal capsular opacification occurred in the operated eyes, regardless of the presence of melanin.
Bioactive Polymers 53: Synthesis of Poly(Vinyl Alcohol) and Nalidixic Acid Based Pro-Drugs
Authors: Dumitriu S. , Blascu V.
Published: June 2017

The present paper studies the process of esterification of nalidixic acid on poly(vinyl alcohol). The influence of time, dilution and concentration of the reactants on the efficiency of esterification with dicyclohexylcarbodiimide has been followed. By experiment scheduling according to a centered, rotatory, compound, second order program, optimum conditions for the system under study have been found. On the other hand, the evolution of reaction of esterification of the nalidixic acid on poly(vinyl alcohol) was followed by using the activator-catalyst (4-pirolidinopyridine) system. An increase of the esterification yield up to 37% has been observed.
In Vitro Antimicrobial Activity of a New Antiseptic Central Venous Catheter
Authors: Li Chunhua , Zhang Xianping , Whitbourne Richard
Published: June 2017

A central venous catheter coated with a new antiseptic combination, silver chloride (AgCl) and benzalkonium chloride (BKC) in a polymer matrix, was developed. The antimicrobial efficacy and the ability to prevent surface colonization, after elution in both serum and saline, were evaluated and compared to catheters coated with silver sulfadiazine/chlorhexidine. The results of in vitro assays demonstrated that the AgCl-BKC coated catheters had a broad spectrum of activity against bacteria and C. albicans and prolonged antimicrobial activity for extraction periods of up to 30 days. These data suggest that AgCl-BKC coated catheters may provide another solution for reduction of catheter-related infections.
Reduction of Calcification by Various Treatments in Cardiac Valves
Authors: Rao K. Panduranga , Shanthi C.
Published: June 2017

The importance of glutaraldehyde pretreated bioprosthetic heart valves fabricated from bovine pericardium or porcine aortic valves is well realized in the management of valvular heart diseases. But, calcification limits the durability and is the most frequent cause of failure of these bioprosthetic heart valves. Various research groups in the world are actively involved in describing, understanding, and preventing calcification of bioprosthetic heart valves. Since there is no satisfactory clinical means for preventing or treating this disorder, attempts are made to improve the anticalcification properties of the replacement valves in the preparation stage itself. Research in this area is very active, and many newer approaches are made to mitigate the problem. An attempt has been made in the present article to review various theories put forward to explain the causative factors involved and mechanistic aspects of biocalcification and to present various strategies attempted for the prevention of calcification with the special feature on the work done in the area in our laboratory.
New horizons of vehicle aerodynamics
Authors: Jessing Christoph , Stoll Daniel , Kuthada Timo , Wiedemann Jochen
Published: June 2017

Vehicle aerodynamics and wind tunnel technology are progressing towards more realistic simulations of the real-world on-road environment. This paper presents an overview of the new systems which were implemented during the recent wind tunnel upgrade at Forschungsinstitut für Kraftfahrwesenund Fahrzeugmotoren Stuttgart as well as comparable computational fluid dynamics simulations. The fully interchangeable road simulation system features an interchangeable five-belt system and three-belt system in the same full-scale automotive wind tunnel. This system offers the efficiency of a five-belt system combined with the more sophisticated ground simulation technique of a wide belt system, which is necessary to assess the aerodynamic properties of sports cars and racing cars. In order to simulate on-road wind conditions, a side-wind generator can be installed to generate a turbulent flow field in the wind tunnel test section. It could be shown that the commonly determined drag coefficient at 0° yaw angle in the smooth flow environment of today’s wind tunnels is not representative of the drag found in real on-road wind conditions. Additionally, the investigations in unsteady side-wind conditions indicate that the commonly used approach to determine the side-wind sensitivity of a vehicle underestimates the forces occurring in turbulent flow conditions. A validated simulation model is presented. The simulation results are in good agreement with the experimental results and can be used as a complementary tool when assessing the unsteady aerodynamic behaviour of a vehicle; this behaviour can be coupled to a vehicle dynamics model for virtual road testing in the Stuttgart full-motion driving simulator. The unsteady-behaviour effects can be evaluated comprehensively, and the results allow a subjective assessment of the unsteady response of the vehicle. Furthermore, the aeroacoustic wind noise in on-road wind conditions is investigated during the development of the vehicle. The side-wind generator reproduces the natural stochastic cross-wind and allows the effect of these wind conditions to be investigated in the aeroacoustic wind tunnel. The results show similar ratings to those in on-road tests when compared with subjective listening tests. In summary, the techniques introduced open up new horizons in the field of vehicle aerodynamics and aeroacoustics, which are a step closer towards real-world conditions in automotive engineering.
A universal approach to squeal analysis of the disc brakes involving various types of uncertainty
Authors: Lü Hui , Shangguan Wen-Bin , Yu Dejie
Published: June 2017

On the basis of fuzzy random variables, a universal approach to squeal analysis of the disc brakes involving various types of uncertainty is proposed in this paper. In the proposed approach, first, the brake stability analysis function related to reliability is constructed with fuzzy random variables. Next, the fuzziness represented by fuzzy random variables is decomposed into interval uncertainties by using a level-cut strategy. Then, the expectations and the variances of the brake stability analysis function are approximately solved by the random moment method at different cut levels, and the lower bounds and the upper bounds of the expectations and the variances are calculated by using a first-order Taylor expansion and a subinterval analysis. Finally, by combining the different interval solutions with the corresponding cut levels, the fuzzy solutions of the brake stability analysis function are obtained, which can be employed to evaluate the brake squeal instability. The proposed approach provides a universal framework for dealing with various types of uncertainty that may exist in automotive brakes. The universality, the accuracy and the efficiency of the proposed approach to the squeal instability analysis of the brakes involving various types of uncertainty are verified by the analysis results from nine different numerical examples.
Behaviour of under sleeper pads at switches and crossings – Field measurements
Authors: Le Pen Louis , Watson G , Hudson A , Powrie W
Published: June 2017

Major growth in rail traffic in many parts of the world in recent years has brought railway networks close to capacity and restricted the time available for track access to carry out maintenance work without costly temporary route closures. There are, therefore, significant benefits in designing or modifying ballasted track systems to reduce maintenance and associated access requirements. Under sleeper pads (USPs) offer the potential to extend ballasted track system life and to extend the intervals between routine maintenance. This paper presents and evaluates field measurements, made using geophones and high speed filming with digital image correlation (DIC), of the performance of a renewed section of track incorporating two switches and crossings (S&C) over a period of two years. One S&C was fitted with two types of USP (categorised as medium and soft), while the other had no USPs and acted as a control. Measurements demonstrate that the bearers with USPs fitted showed less variability in movement than bearers without USPs fitted. The provision of soft USPs caused large increases (>40%) in vertical bearer movements relative to bearers without USPs, although the medium USPs showed little difference. Increased movements of elongated bearers supporting both tracks fitted with soft USPs led to increased bearer rotations towards the loaded track. This effect was aided by the rigid steel collar fixing in the middle of the bearer used in this design of S&C, and raises questions concerning the desirability of this feature. DIC measurements showed that the at rest position of the elongated bearers rotated towards the track on which a train had most recently passed.
Estimation of track parameters and wheel–rail combined roughness from rail vibration
Authors: Li Qi , Thompson David J , Toward Martin GR
Published: June 2017

Rolling noise from running trains is significantly influenced by the wheel–rail combined roughness and the dynamic properties of the track. To facilitate predictions of vibration and noise, it is desirable to be able to determine these parameters accurately from field measurements. In this study, an inverse method for the determination of these parameters is adopted and enhanced. A track model that is based on a wavenumber finite element model of the free rail coupled to discrete supports, which allows for the pinned–pinned mode and cross–sectional deformation of the rail, has been used. The rail vibration induced by hammer impacts and the vibration during train passages are simulated using this model, and these results are then applied to illustrate the accuracy of the direct and indirect methods for the estimation of track decay rate. These methods are compared in a case study for a ballasted track for which hammer impact and train pass–by measurements have been obtained. Other track parameters can also be extracted from the measured data by using the advanced track model. Thereafter, a more complete method is adopted to estimate the wheel–rail combined roughness from the measured rail vibration under train passages. A comparison is made among the estimated roughness levels obtained from this full method, an existing simplified method and the direct measurement method. It is found that the simplified method overestimates the roughness around the pinned–pinned resonance frequency, but gives a good estimation if the track decay rates of the loaded track are used.
The impact of diabetes on CD4 recovery in persons with HIV in an urban clinic in the United States
Authors: Zuniga Julie A , Easley Kirk A , Shenvi Neeta , Nguyen Minh L , Holstad Marcia
Published: June 2017

The purpose of this study was to exam the impact of type 2 diabetes mellitus (T2DM) on CD4 cell count trends in adults with HIV. In a longitudinal retrospective study in an urban primary care HIV clinic in the southeastern United States from 2010 to 2012, patients with HIV medical charts were audited to obtain their CD4 cell count, diabetes status, weight, and demographic information. Rates of increase of CD4 T cell count (i.e. slopes) were obtained using a linear mixed-effects model. Most of the HIV–T2DM cohort (n = 262) and HIV-only cohort (n = 2399) were African American (76%) and male (77%). The CD4 T cell counts were consistently higher in the HIV–T2DM cohort ( p < .0001). The mean rate of CD4 T cell count increase (mean ± SE) was 63 ± 9 cells/µl/year in HIV–T2DM African American women and 28 ± 7 cells/µl/year in HIV–T2DM African American men ( p = 0.003). In the multivariable slope analysis, the CD4 T cell count increase was significantly faster for HIV–T2DM African American women than for all other patients (mean difference = 30/cells/µl/year, 95% CI: 13–47; p < 0.001). Gender, race/ethnicity, and the diagnosis of diabetes influenced the recovery of CD4 cell counts.
Application of exergy analysis to improve the heat integration efficiency in a hydrocracking process
Authors: Goodarzvand-Chegini Fatemeh , GhasemiKafrudi Esmaeil
Published: June 2017

Heat integration techniques are now widely used for energy saving in petroleum processes. In this paper, an industrial hydrocracking process (UOP license) is retrofitted by pinch analysis as a significant tool for heat integration. The hydrocracking process is a main important conversion process in oil refineries and there has been sustained effort to improve its energy efficiency. Application of pinch analysis in retrofit of this process shows the heat exchanger network is operated efficiently. However, a large amount of energy is wasted from the hydrocracking unit, which their condition make no of use directly by the process during pinch analysis. Actually, most of the refining petroleum processes use considerably more energy than the operational minimum energy requirements because of their energy losses. These external energy losses are due to many factors, including normally inefficient or outdated equipment and process design, inadequate heat recovery, and poor integration of heat sources and sinks. However, without identifying the quality of the energy losses, it is difficult to determine how much of that energy is feasible to recover under realistic plant operating conditions. This is where exergy analysis can significantly assist in determining energy recovery opportunities. Thus, this paper is addressed to researchers who are assessing the quality of energy wasted in hydrocracking process, by using the principles of both pinch and exergy analysis. Based on the result obtained, the flue gas exhaust and the high pressure drop in reaction section can be considered as the exergy loss sources in this process. Moreover, the portion of waste energy that can be practically recovered is quantified.
Obsessional subjectivity in societies of discipline and control
Authors: Roberts John L.
Published: June 2017

Drawing on the work of the later Foucault, especially that concerning disciplinary power and bio-power, as well as Deleuze on the emergence of “societies of control,” this article traces the trajectory of obsessional subjectivity from its emergence as a firmly psychiatric category within a disciplinary matrix (i.e., monomania) toward its contemporary position within the bio-political sphere (i.e., obsessional neurosis and obsessive–compulsive disorder) in societies of control. It is argued—pursuant to Lacanian formulations—that obsessional neurosis simultaneously contributes to the efficacy of the workings of bio-power in imagining, vis-à-vis university discourse, a psychologized and psycho-biographical subject knowable and traceable, while also conferring an openness in being that would surmount the dysfunctionality inhering in repetitious thinking and doubt. The aim of this essay is to discern the structural dimensions of mechanisms of obsessional subjection as they implicate certain changing forms of power, and specifically that of our current predicament in the West, in a world where desire and the production of knowledge are governed through bio-power.
A mid- to late-Holocene record of vegetation decline and erosion triggered by monsoon weakening and human adaptations in the south-east Indian Peninsula
Authors: Cui Meng , Wang Zhanghua , Nageswara Rao Kakani , Sangode S J , Saito Yoshiki , Chen Ting , Kulkarni Y R , Naga Kumar K Ch V , Demudu G
Published: June 2017

The mid- to late-Holocene monsoon decline led to aridification of the Indian Peninsula impacting the early agricultural practices in the region. Our analysis of organic carbon, mineral magnetic properties and AMS 14C dating of a 54.2-m-long sediment core (CY) from the Godavari Delta, India, showed changes in the organic carbon source and sediment provenance, which are linked to the changes in vegetation and soil/rock erosion caused by widespread aridification and associated human adaptation in central India. Our results show a decline in the concentration of ferrimagnetic minerals, indicating reduced input from the basalts of the Deccan Plateau after ~6.0 cal. ka BP in response to the weaker Indian monsoon. δ13C values show a distinct increase from ~4.9 cal. ka BP, indicating an increase in C4 plant sources under the continued weak monsoon phase, whereas a higher ferrimagnetic mineral concentration in the sediment suggested an increased Deccan basalt source. Abrupt increase in δ13C values and decrease in TOC content accompanied with a significant increase in ferrimagnetic mineral concentration from ~3.2 to 3.1 cal. ka BP reflected a shift of organic carbon and sediment source and a severe decline in vegetation coverage. Such phenomena indicate intensified deforestation and soil/rock erosion in the Deccan Plateau producing higher ferrimagnetic mineral inputs, which is in agreement with significant expansion of agricultural activities in the Deccan Chalcolithic cultural period. In addition, C3 plants recovered and magnetic concentration declined during the wet events (4.6 and 4.0 cal. ka BP) of Neolithic time, while both C3 plants and magnetic parameters increased during the wet events (3.1–2.8 and 2.1 cal. ka BP) of the Chalcolithic cultural period. This implies increased agricultural activity and the onset of human modification of the ecosystem.
Pronouns of Address and Social Negotiation in as You Like it
Authors: Calvo Clara
Published: June 2017

None of the extant approaches to Early Modern English you and thou can satisfactorily account for all types of pronominal shift present in Shakespeare's plays. The difficulty often lies in swift changes of pronoun performed by one speaker while addressing the same hearer, sometimes in the course of the same dramatic scene or even within the same conversational turn. In this article, some landmarks in the study of the pronouns of address — Brown and Gilman (1960), McIntosh (1963), Wales (1983) — are briefly discussed before concentrating on some of the problems posed by Celia's and Rosalind's shifts of pronominal choice in As you like it. McIntosh's analysis of you and thou in this play is questioned, and the shortcomings of approaches in terms of the norm/deviation or marked/unmarked dichotomies lead to the conclusion that the pronouns of address in Early Modern English must have fulfilled other functions beside those of conveying ‘expressive’ or ‘attitudinal’ overtones. Finally, it is suggested that you and thou might have functioned as markers of in-group or out-group relations in the negotiation of social identities, and as discourse markers signalling a change of conversational topic and the presence of a boundary in the structure of the dialogue.
Trace Element Concentrations in Commercially Available Solutions
Authors: Hoffmann Richard P. , Ashby Daniel M.
Published: June 2017

The use of trace-elements in intravenous hyperalimentation solutions has been recommended for long-term therapy. Very little information is available concerning the presence of these nutrients as contaminants in commercially available solutions. In view of this, the concentrations of copper and zinc were measured in twenty solutions by atomic absorption. The results indicate that the amounts present may be significant in certain solutions.
Indexable Imprinting of Solid Dosage Forms
Authors: Collier W. A. L.
Published: June 2017

A system of indexable imprinting on solid dosage forms is presented which would provide for rapid easy identification. If adopted by the pharmaceutical industry such an indexable system would provide safeguards for the patient by making it more difficult for him to take the wrong drug, would provide a means of rapid identification in case of overdose or poisoning, and would make identification more foolproof in the drug use process in the hospital, community pharmacy and home. The tabulation called IMPREX, already used to tabulate existing imprints and can contain The Adrian Code. Both are described and illustrated.
Sex Variation and Drug Therapy
Authors: Proksch Richard A. , Lamy Peter P.
Published: June 2017

A literature review of gender differences with drug therapy is presented.

Physiological differences between the sexes in basal metabolic rate and in levels of certain of the circulating hormones and enzymes affect or influence the metabolism of various drugs. Differences in muscle mass, disposition of adipose tissue and vascular resistance can lead to variations in response between the sexes to IM injections, while plasma levels of orally administered drugs can be influenced by sex differences such as gastric motility and secretion, metabolic rate, pregnancy, and differences in drug distributive compartments. These differences in gender response to a given therapy can vary according to the patient's age. Adverse reactions to drugs are also affected by the patient's gender, and certain drugs have been shown to induce adverse reactions predominantly in one sex.

The review illustrates the confusion surrounding this subject and stresses the importance of sex differences in the consideration and monitoring of drug therapy. Information on sex and age of patients, and possible sex differences in response to drug therapy is requested of all future therapeutic studies.

It was further suggested that the dual genetic coverage may be the mechanism by which the sex difference in susceptibility to infection can be explained. Support for this theory can best be found in a brief discussion of sex-linked diseases. The transmission from parents to offspring of defects, which may manifest themselves as disease, may be genetic in origin (Table 2).41

Due to the transmission of these diseases by the sex chromosomes, the male, having only one X-chromosome, is afflicted more often by these diseases. This leads one to conclude that given like conditions, females are better adapted to cope with many human diseases because they are genetically and chemically better evolved.
Oxacillin-Induced Agranulocytosis
Authors: Scalley Robert D. , Roark Richard D.
Published: June 2017

Schultz's Disease — Drug allergic agranulocytosis — Is a syndrome characterized by a sudden decrease in circulating granulocytes, necrotic lesions of the oral mucosa, and general symptoms of severe prostration. This is a life threatening condition which is thought to be caused by an immune mechanism. Although identification of specific antibodies has not been successful in all cases, clinical responses in many reports also suggest an allergic basis for this syndrome. The appearance of agranulocytosis is reported in a 79-year-old woman receiving three drugs associated with this dyscrasia. Identification of the most likely causative agent is discussed, and the importance of allergic drug reactions is demonstrated.
Drug Information Centers: Lack of Generic Equivalence
Authors: Halbert Michael R. , Kelly William N. , Miller Douglas E.
Published: June 2017

A survey was carried out in order to observe the level of practice of pharmacists in drug information centers. The underlying assumption to the survey was that, once informed of the existence of a Drug Information Center, a major determinant to the continued utilization of that source would be a subjective impression of the quality and the competence demonstrated in response to the user's initial question.

Ninety Drug Information Centers were contacted by telephone with a standard question. The question was multifaceted, requiring identification, toxicity, therapeutic use, and dose information. The caller identified himself as Dr. Jones and proceeded through a written protocol of conversation. Ten centers could not identify the product. Twenty-three centers initially asked questions other than to verify the correct spelling. Forty-eight centers took advantage of the opportunity to have input into making a judgemental therapeutic decision. Twenty-seven centers offered to document the conversation through a written follow-up. Twenty-two centers provided information judged to be less than adequate in response to the total survey question. It was observed that subjective analysis based on a single telephone conversation could not be used to adequately evaluate an individual drug information center. However, trends observed by contacting every known center indicated that there is a lack of a minimum standard of quality and competence that can be associated with calling a “generic” drug information center.
The Pharmaceutical Industry's Obligation to Clinical Pharmacists
Authors: Katz Seymour , Triboletti Mary
Published: June 2017

The authors have compiled an outline of information they feel the pharmaceutical industry is qualified and obligated to provide the clinical pharmacist. The information requested includes the knowledge most often required by the pharmacist to actively participate in and contribute to patient therapy.

The outline requests much information currently not available in product information or standard textbooks, e.g., pKa, inert ingredients, specific antidote.

If the pharmaceutical companies supplied the information requested in this outline, the clinical pharmacist would have virtually all the knowledge he needs in one convenient source.
Topical Androgen Treatment for ACNE a Review
Authors: Vermorken A. J. M. , Houben J. J. G.
Published: June 2017

Acne results from the increased production of sebum and the accumulation of sebum in the sebaceous duct. Androgens have a direct influence on this condition as they stimulate both the formation of sebum and the hyperkeratinisation of the upper part of the duct which leads eventually to its obstruction.

Clinical tests have demonstrated that most acne patients do not have an increased level of androgen in the blood. They do, however, show an increased conversion of testosterone to 5-alpha-dihy-drotestosterone (5-alpha-DHT) in the skin. This latter hormone is responsible for the stimulation of the sebaceous gland. The enzymic conversion of testosterone to 5-alpha-DHT can be inhibited by progesterone.

Progesterone, when applied topically in an alcohol/water solution, is 80 percent metabolized in the skin and is not converted into androgens in the body. It may therefore be expected that the topical application of progesterone will not give rise to side effects in either men or women. Preliminary trials are in agreement with this expectation.

Extensive clinical investigations of an alcohol/ water solution of progesterone are therefore recommended, as this may be the first clinically useful, locally active, antiandrogen to be effective in the treatment of acne.
Activated Charcoal Adsorption of Theophylline in Vitro
Authors: Sintek Charles , Hendeles Leslie , Weinberger Miles
Published: June 2017

This study was initiated to evaluate the in vitro efficacy of activated charcoal as a potential agent in the treatment of acute theophylline overdoses. Two, ten, and twenty mg/ml solutions were analyzed for theophylline concentration by high-pressure cation-exchange chromatography before and after shaking with 10 g of activated charcoal. The results indicate that 1 g of activated charcoal may adsorb in vitro as much as 300 mg of theophylline. Controlled studies in humans are now indicated.

A wide variety of written forms of prescription drug information for patients are catalogued and discussed. These materials are designed to be delivered by the pharmacist, the physician or the nurse, or to serve as general reference material provided directly to consumers. Materials that describe specific prescription drugs come in the form of stickers or folded sheets directly attached to the medicine container, checklists, wallet or index card size materials, one page sheets, leaflets, brochures and booklets. The best form of patient oriented prescription drug printed material must be evaluated in the context of the goal that it is desired to achieve. Whereas shorter materials are more apt to be read, they cannot provide complete information, the rationale or explanations for the cause or prevention of therapeutic or adverse drug effects.

The importance of providing written prescription drug information to patients is indicated by the fact that many health care professionals produce or distribute these materials to augment and reinforce verbal consultation. In addition, consumer surveys indicate that written communication is a preferred source for this additional information. The examination of existing forms of written prescription drug information for patients is particularly relevant to the Food and Drug Administration (FDA). Senior officials in the FDA have announced support for the concept of written reinforcement of verbal consultation and have said that plans will be proposed for the expanded requirement of patient oriented prescription drug labeling via patient package inserts.
A Trial Using Early Preoperative Administration of Cefonicid for Antimicrobial Prophylaxis with Hysterectomies
Authors: Eron Lawrence J. , Gordon Steven F. , Harvey Lisa K. , Sites James G.
Published: June 2017

A single dose of cefonicid given 3.5–5.0 hours or 0.5–1.0 hour preoperatively was compared with cefoxitin given as five doses beginning 0.5–1.0 hour preoperatively for prophylaxis of infection in 202 patients undergoing vaginal or abdominal hysterectomy. The administration of cefonicid 3.5–5.0 hours preoperatively was intended to simulate situations where surgery may be delayed or prolonged. The trial was double-blind, and patients were randomized to one of the three regimens. Operative site infections were noted in 6.2 percent of patients (7/113) who received cefonicid 3.5–5.0 hours preoperatively, in 7.0 percent of patients (3/43) who received cefonicid 0.5–1.0 hour preoperatively, and in 4.3 percent of patients (2/46) who received cefoxitin (p > 0.05). Enterococci were isolated most frequently from operative-site infections. When administered 3.5–5.0 hours preoperatively, cefonicid was as effective as more traditional regimens.
Myocardial Infarction after Dipyridamole-Assisted Thallium-201 Imaging
Authors: Biddle Paul , Lanspa Thomas J. , Mohiuddin Syed M. , Malesker Mark A. , Hilleman Daniel E.
Published: June 2017

A 77-year-old woman with suspected coronary artery disease underwent an oral dipyridamole/thallium-201 myocardial imaging study. Approximately 75 minutes after ingestion of dipyridamole 300 mg suspension, the patient developed chest pain, hypotension, nausea, and diaphoresis. An electrocardiogram revealed ST-T wave changes suggestive of inferior ischemia. Appropriate therapeutic measures, including aminophylline and nitroglycerin, were instituted. Delayed thallium images revealed reversible ischemia in the anteroseptal and posterobasal regions with a fixed defect in the inferobasal region. Cardiac enzyme studies were also indicative of acute myocardial injury. The patient subsequently underwent coronary arteriography and four-vessel coronary artery bypass grafting and was discharged without further complication. This report raises concerns about the potential danger of dipyridamole in patients with severe coronary artery stenosis and collateral circulation. Prophylactic aminophylline should be considered in these patients.
Do All Histamine2-Antagonists Cause a Warfarin Drug Interaction?
Authors: Thompson Dennis F. , Raebel Marsha A. , Hussey Elizabeth K. , Dukes George E.
Published: June 2017

Cimetidine, the first marketed histamine2-receptor antagonist, has been shown to decrease the clearance of warfarin consistently through inhibition of cytochrome P-450 metabolism. The clinical significance of this drug–drug interaction has been questioned due to: (1) the lowering of the warfarin therapeutic range, (2) the lowering of the total daily therapeutic cimetidine dosage, (3) the advent of once-daily cimetidine dosing, and (4) the demonstration that the clearance of the less active warfarin R-enantiomer is decreased to a greater extent than the more active S-enantiomer. Ranitidine has been implicated in both increasing and decreasing warfarin's hypoprothrombinemic effect (noted in the warfarin package insert), despite the majority of investigations demonstrating no warfarin clearance changes. Careful examination of the implicating data indicates that the majority of the warfarin pharmacodynamic and pharmacokinetic variance that occurs with combined ranitidine-warfarin therapy cannot be attributed to a drug–drug interaction. No data are available to implicate the newer histamine2-antagonists, famotidine and nizatidine, in causing a decrease in warfarin metabolism.
Positioning Pharmacy for the 21st Century
Authors: Doluisio James T.
Published: June 2017

There are always high expectations for a new year—and certainly we will have even higher expectations for a new century. To continue leadership in the 21st century, the American pharmaceutical industry must make a stronger commitment to new product research and development and the profession of pharmacy must commit to development of services needed for new, high-technology products and devices that will often be parenterally administered, bulky, nontraditional, patient-tailored, infrequently administered, and device-oriented. It is suggested that pharmacy must initiate efforts to include drug administration as a pharmaceutical service. Other actions are suggested to modify the curricula preparing pharmacists and to recruit a wider variety of students. A number of other professional initiatives are recommended and discussed to position pharmacy for enhanced clinical services. The issue of subperformance by pharmacists is discussed by pointing out that there is a significant difference in what often is, what should be, and what could be pharmacy service.
Postoperative Analgesic Requirements following Flumazenil Administration
Authors: Olsen Keith M. , Pablo Carmelita S. , Ackerman Bruce H.
Published: June 2017

The effect of flumazenil (RO 15-1788) on postoperative analgesic requirements was evaluated in 30 postoperative patients. This prospective investigation was a double-blind, placebo-controlled trial in patients undergoing general anesthesia supplemented by midazolam and fentanyl or sufentanil. Patients received either flumazenil (n = 20) or placebo (n = 10) by random assignment. Analgesic requirements were measured in morphine equivalents (MEs) and were recorded for a three-hour period following the administration of flumazenil. All patients received the assigned treatment within five minutes of arrival to the postanesthesia room. Total ME requirements were 4.1 ± 3.8 mg for the flumazenil group and 4.5 ± 4.6 mg (p = 0.71) for the placebo group. Patient analgesic requirements were also assessed when patients were adequately alert. For the flumazenil group this time period was 6.2 ± 12.7 minutes versus 52.9 ± 28.4 minutes for placebo (p<0.01). MEs (flumazenil 4.1 ± 3.8 mg vs. placebo 3.7 ±3.2 mg) were not significantly different (p=0.57) when similar levels of consciousness were compared. The onset of pain was more rapid with flumazenil patients as evidenced by the first analgesic dose at 15.7 ± 25.1 minutes for the flumazenil group versus 34.7 ±43.7 for the placebo group; however, these data were not statistically different (p=0.144). These results suggest that flumazenil does not increase postoperative analgesic requirements during the immediate postanesthesia period; however, patients receiving flumazenil may experience an earlier onset of postoperative pain.
Severe Hyponatremia: An Association with Lisinopril?
Authors: Hume Anne L. , Jack Brian W. , Levinson Paul
Published: June 2017

A 63-year-old white woman with a history of hypertension and chronic obstructive pulmonary disease presented to the emergency room with worsening shortness of breath, anorexia, coughing, increased thirst, and leg edema of two weeks' duration. Medications included lisinopril 10 mg/d, which had been started six weeks earlier, sustained-release theophylline 300 mg q12h, and an albuterol inhaler. The lisinopril was discontinued on admission. Serum sodium concentration was 109 mmol/L; the osmolality of the blood and of the urine were 253 mOsmol and 438 mOsmol, respectively, with a specific gravity of 1.025 and a urine sodium of 17 mmol/L. The hyponatremia initially was considered to be the syndrome of inappropriate antidiuretic hormone secretion in response to the patient's suspected pneumonia. Due to worsening blood pressure, lisinopril was restarted and the serum sodium concentration dropped from 134 to 126 mmol/L. Evaluation of the patient's hyponatremia included assessment of thyroid, adrenal, hepatic, and cardiac function that were within normal limits. The patient was discharged on the following medications: Sustained-release theophylline 300 mg tid, prednisone 10 mg/d, albuterol inhaler 2 puffs q6h, and sustained-release verapamil 240 mg/d for blood pressure control. Her serum sodium concentration has remained between 135 and 140 mmol/L during hospitalizations for exacerbations of chronic obstructive pulmonary disease and for pneumonias 10 and 12 months after discharge.
Pancytopenia Secondary to Short-Term, High-Dose Intravenous Infusion of Amrinone
Authors: Mattingly Paul M. , Burnette P.K. , Weston Mark W. , Manny Richard P.
Published: June 2017

The incidence of amrinone-induced thrombocytopenia has been reported to be 2.4 percent in patients receiving intravenous therapy. To date there have been no reports of bleeding in these patients nor have there been reports of other hematologic abnormalities secondary to amrinone administration. This case report describes a patient whose hematologic values began to decrease after two days of amrinone therapy, reaching a nadir at day 8. Values returned to baseline eight days after treatment was discontinued. This report provides the first evidence that amrinone may induce pancytopenia in patients who receive short courses of high-dose, continuous-infusion amrinone.
Massive Hepatic Enlargement with Fatty Change Associated with Ketoconazole
Authors: Gradon Jeremy D. , Sepkowitz Douglas V.
Published: June 2017

Several forms of hepatic toxicity have been described with the antifungal agent ketoconazole. We report a case of massive liver enlargement with fatty infiltration presenting as gastric compression. This occurred in a young woman with AIDS taking ketoconazole as maintenance therapy for cryptococcal meningitis. This is the first reported case of ketoconazole causing fatty change in the liver.
Purdue Stepped Approach Model: Application to Pharmacy Practice
Authors: Black David R. , Loughead Teri A. , Hadsall Ronald S.
Published: June 2017

The Purdue Stepped Approach Model (PSAM) of service delivery is applied to pharmacy practice. The PSAM offers a method to organize interventions in a systematic and sequential manner according to the amount and type of resources required to achieve optimal patient health status. The model also provides an approach to integrating the expertise of other healthcare professionals into the provision of pharmacy services (e.g., health educators, psychologists, nurse practitioners, exercise physiologists), addresses economic costs and differential modes of reimbursement, and provides suggestions for future research. Examples are included to facilitate application of the PSAM in pharmacy and implications for holistic healthcare or health promotion in pharmacy practice are discussed.
Patient Outcome and the Future Practice of Pharmacy
Authors: Hatoum Hind T. , Vlasses Peter H.
Published: June 2017

The societal move to focus on patient healthcare outcomes as a measure of provider performance is discussed. Recent steps taken by the Joint Commission on Accreditation of Healthcare Organizations to include outcome criteria as part of its accreditation process represent one such example. Pharmacists must define and defend their role in patients' pharmacotherapy in terms of patient outcomes. Collective actions needed by pharmacists are recommended.
Pharmacokinetic and Tolerance Evaluation of Actisomide, a New Antiarrhythmic Agent, in Healthy Volunteers
Authors: Malesker Mark A. , Mohiuddin Syed M. , Destache Christopher J. , Stoysich Anne , Dean Richard R. , Hilleman Daniel E. , Sketch Michael H.
Published: June 2017

The pharmacokinetics and tolerance of actisomide (SC-36602) were determined following intravenous doses of 2.1, 4.2, and 8.4 mg/kg infused over five hours. Plasma concentrations observed in the low-dose group (2.1 mg/kg) were below the assay's limit of detection and were not included in the pharmacokinetic analysis. The following pharmacokinetic parameters were obtained in the medium-dose (4.2 mg/kg) and high-dose (8.4 mg/kg) groups, respectively: Peak plasma concentration 4.25 ± 0.26 and 7.81 ± 0.31 μg/mL; area under the plasma concentration versus time curve 19.79 ± 2.96 and 39.81 ±7.05 h • μg/mL; elimination rate constant of the beta phase 0.105 ± 0.77 and 0.093 ± 0.009 h−1; and half-life 8.85 ± 4.61 and 7.51 ± 0.69 h. Left ventricular ejection fraction decreased by 10, 11, and 16 percent in the low-, medium-, and high-dose groups, respectively. Heart rate was not altered during the low-dose infusion. At the medium- and high-dose levels, resting peak heart rate increased by 18 and 27 percent, respectively. Systolic and diastolic blood pressures were not significantly changed in any of the dose groups. Changes in electrocardiographic intervals for the three dose groups were not significant except at the highest dose where an average 20 percent increase in the QRS interval was seen. Mild subjective adverse effects (dizziness, taste perversion, and circumoral paresthesia) which did not necessitate discontinuing the infusion occurred in the highest dosage group. Further studies are warranted to more fully characterize the pharmacokinetic profile and therapeutic potential of actisomide.