bluuebunny/crossref_metadata_2025 huggingface dataset:
Model analysis and verification of 2K-H planetary gear system
Authors: Qian Pei-yun , Zhang Ye-lin , Cheng Gang , Ge Shi-rong , Zhou Chang-fei
Published: September 2013

The planetary gear system is the important part of the cutting unit in a coal shearer, and its performance is directly related to the output efficiency in coal mines. Analyzing the natural frequencies and vibration modes of a planetary gear system in a coal shearer is helpful for designing and monitoring the planetary gear system. So a lateral-torsional coupled free vibration model is proposed with the shaft stiffness of the sun gear based on the analysis of a purely torsional model. The solutions are determined by using the modal superposition method. Taking the planetary gear system in the cutting unit of a YBCS2-400 type coal shearer as an example and studying the natural characteristics, the vibration modes of the undamped system could be classified into three types – rotational mode, translational mode and planet mode. The associated reduced-order eigenvalue for each type of vibration mode is derived and the analytical expression of natural frequency is presented for the planet mode. The established model is validated by comparing it with the results of a finite element model, and the effect on the vibration frequencies of the transmission and width ratio has been obtained by means of the finite element model.
The use of rationalized Haar wavelet collocation method for solving optimal control of Volterra integral equations
Authors: Maleknejad Khosrow , Ebrahimzadeh Asyieh
Published: September 2013

In this paper, an efficient method based on rationalized Haar (RH) wavelets is proposed for the numerical solution of optimal control problem for systems governed by Volterra integral equations with a quadratic performance index. Many problems in economics, biology, epidemiology and memory effects can be modeled as Volterra control problems. The main advantage of the RH wavelet is based on its efficiency and simple applicability. The properties of RH wavelets are represented. The operational matrices of integration and product are given. These matrices are then utilized to reduce the solution of the optimization problem to a nonlinear programming one to which well-developed algorithms may be applied. The convergence analysis of the method and illustrative examples are included to demonstrate the validity and applicability of the technique.
Higher-order differential feedback control of a flexible-joint manipulator
Authors: Agee John T , Bingul Zafer , Kizir Selcuk
Published: September 2013

This paper presents a new control scheme for a flexible-joint manipulator using a higher-order differential feedback controller (HODFC). Two higher-order differential operators were designed and used to perform observations of both the reference input and the output of the manipulator, together with the requisite state derivatives. An error-based state-space model was then derived from the observed states. A pole-placement procedure with filtering was then used to drive the system error to zero. Practical controller implementation was carried out using the dSPACE real-time prototyping system. For the comparative validation of the performance of the HODFC with respect to a classical proportional-integral and proportional-integral-derivative (PID) controller, several experiments were undertaken. In these experiments, the step input, sine waves, kane trajectories, and external disturbances were applied to the controlled flexible-joint manipulator. The results showed that the HODFC controller eliminated disturbances within one second of occurrence, and produced superior kane trajectory tracking. Moreover, based on the root-mean-square tracking error criterion, the HODFC was observed to track both the sine and kane function trajectories with one-fourth the tracking error obtained with classical PID control.
Risk factors related to cardiovascular diseases and the metabolic syndrome in multiple sclerosis – a systematic review
Authors: Wens Inez , Dalgas Ulrik , Stenager Egon , Eijnde Bert O
Published: September 2013

Despite many epidemiological studies examining comorbidity in people with multiple sclerosis (pMS), there are conflicting opinions on whether pMS are at more or less risk of cardiovascular disease (CVD) and the metabolic syndrome compared with the general population. As pMS can now expect longer survival, this as an important question both at an individual and public health level. This study aimed to systematically review the literature linking MS to CVD risks and to the risk factors constituting the metabolic syndrome. This systematic review is based on a comprehensive literature search of six databases (Swemed+, Pubmed, Embase, Cochrane, PEDro and CINAHL). In total 34 studies were identified. Despite the high number of identified papers, only limited and inconsistent data exist on the risk factors of the metabolic syndrome and MS. Overall, the data suggest an increased CVD risk in pMS. From the existing studies it is not clear whether the increased risk of CVD is related to an increased risk of obesity or changes in body composition, hypertension, dyslipidemia or type II diabetes in pMS, indicating the need for future research in the field, if we are to advise pMS adequately in avoiding preventable comorbidity.
Low quality of life and depressive symptoms are connected with an unhealthy lifestyle
Authors: Savolainen Jorma , Kautiainen Hannu , Miettola Juhani , Niskanen Leo , Mäntyselkä Pekka
Published: September 2013

Background: The Lapinlahti 2005 study was carried out to explore cardiovascular disease risk factors, lifestyle and quality of life in Lapinlahti residents in eastern Finland. Our aim was to study the association between lifestyle and health-related quality of life (HRQoL) in the community. Subjects and methods: The present study is based on the baseline data of the followed up (2005–2010) population-based cohort ( N = 376, n of males = 184). A trained research nurse measured weight, height, waist circumference and blood pressure. Self-reported HRQoL was measured using a 15D questionnaire. A BDI-21 inventory was used to assess the presence of self-reported depressive symptoms. Lifestyle factors (nutrition, exercise, smoking and alcohol use) were examined with a structured questionnaire. Each lifestyle item was valued as −1, 0 or 1, depending on how well it corresponded to the recommendations. Based on the index the participants were divided into three lifestyle sum tertiles: I = unhealthy, II = neutral and III = healthy. The age- and sex-adjusted linear trend between the tertiles was tested. Results: The 15D score had a positive linear relationship with the lifestyle tertiles ( P = .0048 for linearity, age- and sex-adjusted). Respectively, self-reported depressive symptoms were less frequent among subjects with a healthier lifestyle ( P = .038). Conclusions: People who are expected to strive most to change their lifestyle have the lowest quality of life and psychological welfare, which should be taken into account in both clinical work and health promotion.
Website design: Technical, social and medical issues for self-reporting by elderly patients
Authors: Taylor Mark J , Stables Rod , Matata Bashir , Lisboa Paulo JG , Laws Andy , Almond Peter
Published: September 2013

There is growing interest in the use of the Internet for interacting with patients, both in terms of healthcare information provision and information gathering. In this article, we examine the issues in designing healthcare websites for elderly users. In particular, this article uses a year-long case study of the development of a web-based system for self-reporting of symptoms and quality of life with a view to examine the issues relating to website design for elderly users. The issues identified included the technical, social and medical aspects of website design for elderly users. The web-based system developed was based on the European Quality of Life 5-Dimensions health-status questionnaire, a commonly used tool for patient self-reporting of quality of life, and the more specific coronary revascularisation outcome questionnaire. Currently, self-reporting is generally administered in the form of paper-based questionnaires to be completed in the outpatient clinic or at home. There are a variety of issues relating to elderly users, which imply that websites for elderly patients may involve different design considerations to other types of websites.
Conversing the audience: A methodological exploration of how conversation analysis can contribute to the analysis of interactive journalism
Authors: Steensen Steen
Published: September 2013

This paper argues that conversation analysis (CA) has much to offer studies of online interactions and, particularly, online interactive journalism. CA provides a methodological opportunity to closely investigate the structure of public discourse in new media platforms, and power relations between journalists and audiences in instances of interactive journalism. The paper introduces CA and discusses how it may be combined with other methods in order to pinpoint the characteristics of online interactions in general and interactive journalism in particular. In the second half of the paper, the CA-inspired methodological approach used to analyse a case study of an interactive live blog in the Norwegian online newspaper VG Nett is presented.
Brand interactivity and its effects on the outcomes of advergame play
Authors: Lee Joonghwa , Park Hyojung , Wise Kevin
Published: September 2013

This study develops the concept of brand interactivity based on the characteristics and definitions of interactivity and applies it to advergames. Brand interactivity is significant in advertising research and practice because this concept extends the perspective of interactivity from media to brands. The results of an experiment indicate that consumers have more positive attitudes toward a brand and stronger purchase intentions when playing advergames with brand interactivity rather than without brand interactivity. As this study shows, the role of brand interactivity in advergames provides insights for advertising scholars and practitioners seeking ways to improve consumers’ experience with brands through interactive media.
Health monitoring of web plastifying dampers subjected to cyclic loading through vibration tests
Authors: Benavent-Climent Amadeo , Gallego Antolino , Romo-Melo Liliana , Morillas Leandro
Published: September 2013

This article investigates experimentally the application of health monitoring techniques to assess the damage on a particular kind of hysteretic (metallic) damper called web plastifying dampers, which are subjected to cyclic loading. In general terms, hysteretic dampers are increasingly used as passive control systems in advanced earthquake-resistant structures. Nonparametric statistical processing of the signals obtained from simple vibration tests of the web plastifying damper is used here to propose an area index damage. This area index damage is compared with an alternative energy-based index of damage proposed in past research that is based on the decomposition of the load–displacement curve experienced by the damper. Index of damage has been proven to accurately predict the level of damage and the proximity to failure of web plastifying damper, but obtaining the load–displacement curve for its direct calculation requires the use of costly instrumentation. For this reason, the aim of this study is to estimate index of damage indirectly from simple vibration tests, calling for much simpler and cheaper instrumentation, through an auxiliary index called area index damage. Web plastifying damper is a particular type of hysteretic damper that uses the out-of-plane plastic deformation of the web of I-section steel segments as a source of energy dissipation. Four I-section steel segments with similar geometry were subjected to the same pattern of cyclic loading, and the damage was evaluated with the index of damage and area index damage indexes at several stages of the loading process. A good correlation was found between area index damage and index of damage. Based on this correlation, simple formulae are proposed to estimate index of damage from the area index damage.
Stent Graft in the Treatment of Pseudoaneurysms of the Hepatic Arteries
Authors: Lü Peng-Hua , Zhang Xi-Cheng , Wang Li-Fu , Chen Zhao-Lei , Shi Hai-Bin
Published: September 2013

Objective:

The purpose of our study was to evaluate the technical feasibility, procedural complications, clinical follow-up, and computed tomography (CT) scan outcomes of hepatic artery pseudoaneurysms (HAPs) treated with stent graft.

Methods:

Between October 2004 and October 2009, we treated 8 patients with HAPs with stent graft.

Results:

Stent graft deployment was technically successful in all the patients. Complete exclusion of the pseudoaneurysm preserving patency of the hepatic artery was achieved in 6 patients. Total occlusion of the common hepatic artery was observed in 1 patient, and vasospasm of proper hepatic artery and endoleak from distal stent margin were observed in another patient. The 2 patient were controlled through occlusion parent artery with coils. After these procedures, symptoms of bleeding and abdominal pain disappeared. Follow-up enhanced CT scan was performed at an average of 14 months (range, 6-26months), which showed complete disappearance of the HAP and patency of the stent without intrastent stenosis in 6 patients who had successful deployment of the stent.

Conclusions:

Endovascular treatment of HAPs using stent graft can maintain the hepatic artery blood flow and could be considered as an alternative to embolization.
Sequential Compression Biomechanical Device Versus Primary Amputation in Patients With Critical Limb Ischemia
Authors: Tawfick Wael A. , Hamada Nader , Soylu Esraa , Fahy Anne , Hynes Niamh , Sultan Sherif
Published: September 2013

Introduction:

Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients.

Objectives:

To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality.

Methods:

From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations.

Results:

All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125.

Conclusion:

The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.
Reproducibility of EEG–fMRI Results in a Patient With Fixation-Off Sensitivity
Authors: Formaggio Emanuela , Storti Silvia Francesca , Boscolo Galazzo Ilaria , Bongiovanni Luigi Giuseppe , Cerini Roberto , Fiaschi Antonio , Manganotti Paolo
Published: September 2013

Blood oxygenation level–dependent (BOLD) activation associated with interictal epileptiform discharges in a patient with fixation-off sensitivity (FOS) was studied using a combined electroencephalography–functional magnetic resonance imaging (EEG–fMRI) technique. An automatic approach for combined EEG–fMRI analysis and a subject-specific hemodynamic response function was used to improve general linear model analysis of the fMRI data. The EEG showed the typical features of FOS, with continuous epileptiform discharges during elimination of central vision by eye opening and closing and fixation; modification of this pattern was clearly visible and recognizable. During all 3 recording sessions EEG–fMRI activations indicated a BOLD signal decrease related to epileptiform activity in the parietal areas. This study can further our understanding of this EEG phenomenon and can provide some insight into the reliability of the EEG–fMRI technique in localizing the irritative zone.
Policing the masculine frontier: Cultural criminological analysis of the gendered performance of policing
Authors: Aiello Michael F
Published: September 2013

This qualitative content analysis project relies on a combined cultural criminological and hegemonic masculinities perspective to uncover constructions of justice workers and the gendered performance of policing. This study provides a typology of hegemonic and “complicit” or subordinate policing and masculinity models in six of the highest-grossing American police movies as well as the representations of the ideal and unqualified officer in the online recruitment materials of departments serving the 25 largest American cities. While “cop films” are an established subgenre within Hollywood, official police websites represent an emergent medium for the dissemination of a cultural self-portrait. By studying these various reflections of the occupation, this project engages with the characteristics, traits, and attributes associated with the police across Hollywood movies and police recruitment webpages, finding stark tensions between the commercially mediated ideal and that of the public transcript of the police. This study theoretically and methodologically develops cultural criminology by addressing the self-portrait of the police alongside models of masculinity and policing provided by consumer-tailored media within the modern “hall of mirrors.”
Spinal cord stimulation: Subjective pain intensity and presurgical correlates in chronic pain patients
Authors: Sumner Lekeisha A , Lofland Kenneth
Published: September 2013

Objectives

This study determined the changes in pain intensity prior to and after permanent placement of spinal cord stimulation (SCS), as measured by the Visual Analog Scale (VAS) and, examined associations of presurgical characteristics to both pre- and post-SCS VAS scores.

Materials and methods

Demographic, disease, and psychological data were extracted from the medical charts of chronic pain patients ( N = 58) being treated at a Hospital in IL, USA. Most patients were diagnosed with complex regional pain syndrome (51.9%) and low back pain (33.3%). The majority were White (72.5%), male (60%), married (72%), and temporary disabled or receiving worker’s compensation (40%). Study objectives were tested with correlational and univariate analysis.

Results

A significant reduction between pre ( M = 6.87; SD = 1.38) and Post-( M = 4.11; SD = 1.54) SCS pain intensity scores was observed ( p < .000). Pre-SCS pain intensity scores were associated with medical diagnosis ( p < .01), marital status ( p < .05), and catastrophizing ( p < .05). Post-SCS pain intensity scores were associated with body mass index ( p < .05), medical diagnosis ( p < .05), employment status ( p < .05), bodily concern ( p < .05), marital status ( p < .05), and race ( p < .05).

Conclusions

Results strengthen support for the short-term effectiveness of SCS and demonstrate the differential associations of presurgical factors on pain intensity.
A field study of thermal inertia of roofs and its influence on indoor comfort
Authors: D’Orazio Marco , Di Perna Costanzo , Di Giuseppe Elisa
Published: September 2013

Many of the current European Member States regulations on energy saving in buildings seem to follow North European trends that call for high insulation of the envelope. However, this kind of set-up overlooks some specific elements that are necessary to build typical buildings in warmer climates. Thermal inertia on the internal surface of the envelope has traditionally been used in such contexts not only to contain solar gains but also to protect against cold winter because of its capacity to store and to slowly release energy. This research investigates how thermal inertia on roof slabs could positively affect the comfort indoors, also in buildings that tend towards being nearly zero-energy buildings, as suggested by last European Directive 2010/31/EU. With this aim, an experiment was conducted on a full-scale building with different roofs, on light and heavy slabs, under hot and moderate climatic conditions (Ancona, Italy). The thermal performance of roofs was monitored during summer and winter seasons. In winter, the building was also subjected to cyclical internal heat gains. The experiment demonstrated that a certain thermal inertia in the slab guarantees better indoor comfort in both summer and winter, and it can also reduce energy consumption from heating.
Energy transfer through single- and double-pane windows subject to wintertime environmental radiation
Authors: Frederick John E
Published: September 2013

This work applies a new model that treats solar and longwave radiative transfer, thermal conduction, and sensible heat transport to quantify the flow of energy across single- and double-pane windows. A set of radiometers based in Chicago, Illinois, observed solar and longwave irradiances incident on and emerging from a window on a low-rise building. The incoming radiation fields, averaged over a 10-day period in January, drive the energy budget calculations, while a comparison of measured and computed outgoing irradiances validates the results. The indoor–outdoor temperature contrast creates a gradient in longwave radiative heating across the glass. This drives a heat flux that increases sensible heat flow to the exterior atmosphere by approximately a factor of 3 over what would exist without thermal radiation. Absorption of sunlight by the glass also increases energy lost to the atmosphere. For the conditions analyzed, approximately 40% of the solar energy absorbed by the window-plus-interior system is returned to the exterior as sensible heat and longwave radiation. The remaining absorbed solar energy offsets the demand for heating from the climate-control system.
Protease-activated receptor-2 deficient mice have reduced house dust mite-evoked allergic lung inflammation
Authors: de Boer J Daan , van’t Veer Cornelis , Stroo Ingrid , van der Meer Anne J , de Vos Alex F , van der Zee Jaring S , Roelofs Joris J T H , van der Poll Tom
Published: September 2013

Protease-activated receptor-2 (PAR2) is abundantly expressed in the pulmonary compartment. House dust mite (HDM) is a common cause of allergic asthma and contains multiple PAR2 agonistic proteases. The aim of this study was to determine the role of PAR2 in HDM-induced allergic lung inflammation. For this, the extent of allergic lung inflammation was studied in wild type (Wt) and PAR2 knockout (KO) mice after repeated airway exposure to HDM. HDM exposure of Wt mice resulted in a profound influx of eosinophils in bronchoalveolar lavage fluid (BALF) and accumulation of eosinophils in lung tissue, which both were strongly reduced in PAR2 KO mice. PAR2 KO mice demonstrated attenuated lung pathology and protein leak in the bronchoalveolar space, accompanied by lower BALF levels of the anaphylatoxins C3a and C5a. This study reveals, for the first time, an important role for PAR2 in allergic lung inflammation induced by the clinically relevant allergens contained in HDM.
Increased International Normalized Ratio in a Patient Taking Warfarin and Celecoxib
Authors: O'Donnell Dannielle C , Hooper Justin S
Published: September 2013

Objective:

To report a case of increased international normalized ratio (INR) associated with the addition of celecoxib therapy.

Case Summary:

A 77-year-old white woman who was previously stabilized at a target INR of 2–3 on warfarin 26.25 mg/wk for recurrent atrial fibrillation presented with “leg pain.” Celecoxib 100 mg twice daily orally was added to her regimen. After approximately three weeks of celecoxib therapy, her INR was elevated at 3.5, with no signs of bleeding. Her warfarin was withheld for one day and reinitiated at 23.75 mg/wk (∼10% decrease). Follow-up INRs at one and three weeks had returned to target INR range between 2 and 3.

Discussion:

Drug interactions are common with warfarin due to induction or inhibitions of the cytochrome P450 system and changes in protein binding. Although the celecoxib package insert states that there is not a significant interaction in healthy subjects receiving 2–5 mg/d of warfarin, the potential exists, as both are highly protein bound and metabolized through CYP2C9.

Conclusions:

This case report suggests that the INR may be increased after celecoxib initiation in patients undergoing anticoagulation. This may heighten the risk for clinically significant bleeding in patients previously stabilized on a warfarin regimen. Clinicians should consider more frequent INR monitoring of patients receiving warfarin after celecoxib is initiated.
Absorption of Clonidine from a Halved Transdermal System — A Pilot Study
Authors: Wong Nina N , Chen Julie L , Luks-Golger Denise
Published: September 2013

Objective:

To assess whether clonidine bioavailability is compromised when a transdermal system is cut in half.

Methods:

Seven healthy volunteers were enrolled in this prospective crossover study. In phase I, an intact clonidine 0.1 mg/24 h transdermal system (TS-1) was applied and plasma clonidine concentration was obtained 72 hours after application, after steady-state (48–72 hours) was purported to have been reached. After a minimum seven-day washout period, half of a clonidine 0.2 mg/24 h transdermal system (½TS-2) was applied in phase II, with plasma clonidine concentrations obtained at 24, 48, 72, 120, and 192 hours following application.

Results:

Mean plasma clonidine concentrations at 72 hours with TS-1 in phase I were 0.17 ± 0.07 ng/mL. Mean plasma clonidine concentrations at 24, 48, 72, 120, and 192 hours with ½TS-2 in phase II were 0.16 ± 0.11, 0.15 ± 0.06, 0.15 ± 0.05, 0.19 ± 0.4, and 0.20 ± 0.8 ng/mL, respectively. There was no statistically significant difference between mean concentrations at 72 hours in phases I and II, but individual clonidine concentrations between phases varied 50–286%. Individual concentration versus time curves obtained from subjects in phase II lacked a consistent pattern.

Conclusions:

Although there was no statistically significant difference in mean concentrations at 72 hours, individual clonidine concentration variations may have a clinically significant impact. The lack of a consistent plasma concentration versus time pattern may also be of clinical concern. Based on these results, cutting the clonidine transdermal system may compromise its integrity, and is therefore not recommended.
Discontinuity of Outpatient Antipsychotic Pharmacotherapy: Risperidone Maintenance after Hospitalization
Authors: Malan Randy D , Luchins Daniel J , Fichtner Christopher G , Hanrahan Patricia , Klass David B
Published: September 2013

Objective:

To investigate continuity of outpatient antipsychotic pharmacotherapy with risperidone in patients discharged from state psychiatric hospitals.

Methods:

Of 1,201 patients discharged from Illinois state psychiatric hospitals while taking risperidone during the first year of the medication's commercial availability, 627 public aid–eligible patients were trackable on the basis of public aid billing data. Data on risperidone continuation and other medication use for these patients were collected for the two-year period following each patient's discharge.

Results:

Forty-four percent of the patients discontinued risperidone within two weeks of hospital discharge, with one-half receiving no medications and most of the remainder switching to other antipsychotics. More than 75% of the patients discontinued risperidone within one year of hospital discharge, and fewer than 1% received continuous risperidone pharmacotherapy for the two-year follow-up period.

Conclusions:

Although the study methods do not permit us to draw conclusions regarding specific reasons for risperidone discontinuation in this patient sample, 66% of whom had a diagnosis of schizophrenia or schizoaffective disorder and 86% of whom had psychotic diagnoses, the rapid drop-off and discontinuity in medication management following hospital discharge is almost certainly inconsistent with optimum clinical care for this group of patients. Discontinuities in maintenance pharmacotherapy may compromise medical effectiveness, even for newer antipsychotic medications such as risperidone.
Fluoroquinolone E-Testing against Pseudomonas Aeruginosa and Streptococcus Pneumoniae
Authors: Sahloff Eric G , Smith Benjamin P , Martin Steven J
Published: September 2013

Objectives and Design:

The use of fluoroquinolones has increased against antibiotic-resistant pathogens such as Streptococcus pneumoniae and Pseudomonas aeruginosa. The E-test (AB Biodisk, Solna, Sweden) is now commonly used for susceptibility testing of fluoroquinolones against these organisms. The purpose of the present study was to evaluate the accuracy and correlation of minimum inhibitory concentrations (MICs) determined by E-testing with a National Committee for Clinical Laboratory Standards reference standard, agar-dilution MIC testing. E-test and agar dilution MICs were compared for ciprofloxacin, levofloxacin, gatifloxacin, and moxifloxacin against clinical isolates of S. pneumoniae (n = 53) and P. aeruginosa (n = 62).

Main Outcome Measures:

MICs were determined by use of agar dilution and E-test methods. Essential agreement was defined as MICs from both methods within ± 1 log2 dilution. Categorical agreement compared MIC interpretations: susceptible, intermediate, or resistant. Categorical disagreement between methods was reported as very major, major, or minor errors.

Results:

E-tests produced lower MICs than the reference method for ciprofloxacin, gatifloxacin, and moxifloxacin versus P. aeruginosa. For S. pneumoniae, E-test MICs tended to be higher for all fluoroquinolones. The best correlation between testing methods was seen with levofloxacin. Essential agreement occurred more frequently with P. aeruginosa in the lower range of MICs and with S. pneumoniae in the higher range of MICs. Categorical agreement was greater than 90% for the 460 comparisons. Two very major errors (false-susceptible) occurred for gatifloxacin versus P. aeruginosa.

Conclusions:

For the determination of fluoroquinolone susceptibility against S. pneumoniae and P. aeruginosa, E-testing is a simple tool for clinical use, and few very major or major errors in susceptibility interpretation occur for either organism. For determining fluoroquinolone MICs, E-testing may overestimate drug activity against P. aeruginosa and underestimate drug activity versus S. pneumoniae compared with the agar dilution method. These differences could affect appropriate antimicrobial selection, leading to suboptimal outcomes.
Assessing Home Health Care Pharmacists' Knowledge of Cytochrome P450 Pharmacogenetics
Authors: Rogers Janyce F , Kidd Robert S
Published: September 2013

Objective:

Genetic code governs cytochrome P450 activity as a consequence, it may influence an individual's response to medications metabolized by these enzymes. Pharmacists have a prominent role in providing education concerning adverse drug reactions and variability in drug response. This investigation assessed the knowledge of a group of pharmacists regarding cytochrome P450 pharmacogenetics.

Methods:

This observational, cross-sectional study presented a Web–based questionnaire available for completion by pharmacists contacted via E-mail. Fifty-two pharmacists involved with a nationwide home-care facility participated in the study on a volunteer basis. The main outcome measure was percentage score on a 10-question examination.

Results:

Fifty-two of 171 contacted pharmacists participated in the study, yielding a response rate of 30%. The mean percentage questionnaire score ± SD was 17.5 ± 15.1. Scores were slightly higher for pharmacists with 2 or more pharmacokinetic classes in their formal education (p < 0.02).

Conclusions:

Understanding the principles of pharmacogenetics will allow pharmacists to appreciate that patients respond differently to certain medications as influenced by genetic variations encoding drug-metabolizing enzyme activity. As a consequence, some patients will have a normal therapeutic response, whereas others may experience drug toxicity or therapeutic inefficacy when given the same dose of a drug. This study determined, albeit with many limitations, that there is likely a need for improved availability of pharmacogenetic continuing education programs.
G-CSF and Erythropoietin Stability in Amniotic Fluid during Simulated in vitro Digestion Conditions
Authors: Calhoun Darlene A , Richards Brooke E , Gersting Jason A , Sullivan Sandra E , Christensen Robert D
Published: September 2013

Objective:

To determine the stability of granulocyte colony-stimulating factor (G-CSF) and erythropoietin (Epo) in human amniotic fluid and recombinant G-CSF (Neupogen) and Epo (Epogen) in simulated amniotic fluid to digestions at pH concentrations of 3.2, 4.5, and 5.8 to assess their bioavailability to the neonate.

Design:

A simulated amniotic fluid containing Neupogen and Epogen was subjected to in vitro conditions that mimicked preprandial and postprandial neonatal intestinal digestion. Human amniotic fluid was tested using identical digestion conditions as well as human amniotic fluid to which Epogen and Neupogen had been added.

Main Outcome Measures:

The percentages of G-CSF/Epo and Neupogen/Epogen remaining after 1 and 2 hours of simulated digestions were compared with those at time zero, and concentrations at 2 hours were compared with those at 1 hour and time zero.

Results:

In simulated amniotic fluid at pH 3.2, significant degradation of G-CSF was observed at 1 hour (p = 0.03). No differences were observed at 1 or 2 hours for either pH 4.5 (p = 0.30 and 0.11, respectively) or pH 5.8 (p = 0.20 and 0.49, respectively). Human amniotic fluid exhibited significant degradation pH 3.2 (p = 0.04) and pH 4.5 (p < 0.05) at 1 hour; no difference was noted at pH 5.8 at 1 hour (p = 0.34). When additional Neupogen was added to human amniotic fluid, significant degradation was observed at pH 3.2 (p < 0.05) and pH 4.5 (p = 0.03) at 1 hour; no difference was noted at 1 hour at pH 5.8 (p = 0.11). In simulated amniotic fluid at pH 3.2, significant degradation of Epo occurred at 1 hour (p < 0.05). There were no differences at 1 hour for pH 4.5 (p = 0.50) or pH 5.8 (p = 0.17). Human amniotic fluid exhibited significant degradation at pH 3.2 (p < 0.05) and pH 4.5 (p < 0.05) at 1 hour; no difference was noted at 1 hour at pH 5.8 (p = 0.34). When additional Epogen was added to human amniotic fluid, significant degradation was observed at pH 3.2 (p = 0.001) and pH 4.5 (p = 0.003); no difference was noted at 1 hour at pH 5.8 (p = 0.31).

Conclusions:

G-CSF/Epo in human amniotic fluid and Neupogen/Epogen in simulated amniotic fluid are preserved to varying degrees during simulated digestion conditions. The degree of degradation of both cytokines was time- and pH-dependent. Measurable quantities of G-CSF and Epo are biologically available when swallowed by the fetus or a preterm neonate.
Evaluation of Eptifibatide Treatment in Patients Undergoing Percutaneous Coronary Intervention
Authors: Sheikh-Taha Marwan T , Strickland Warren L
Published: September 2013

Background:

Abrupt closure and restenosis remain serious and costly consequences of coronary angioplasty procedures. Eptifibatide (Integrilin) has been shown to decrease the rate of combined endpoint of death, new myocardial infarction, or the need for urgent intervention in this setting. Platelet aggregation is inhibited by eptifibatide in a dose-dependent manner, with more than 80% receptor occupancy required to prevent thrombus formation.

Objective:

To evaluate the safety and efficacy of a shorter duration of treatment with eptifibatide in low-risk patients undergoing percutaneous coronary intervention.

Methods:

We compared low-risk patients undergoing percutaneous coronary intervention who received either conventional eptifibatide dosing or a bolus dose that was sufficient to produce more than 80% platelet inhibition. All patients were followed for major adverse cardiovascular events (MACE) for 90 days after the procedure. MACE complications included death, myocardial infarction (defined as elevation of the creatine kinase-MB fraction at least 3 times the upper limit of normal or new Q-waves in 2 electrocardiographic leads), or any treatment for recurrent angina (percutaneous transluminal coronary angioplasty, stent placement, or coronary artery bypass grafting). Safety was assessed by the incidence of bleeding and thrombocytopenia.

Results and Conclusions:

None of the patients in either study group had a MACE or thrombocytopenia during the follow-up period. Patients who received a conventional eptifibatide dose had a higher incidence of minor bleeding. It appears that, in low-risk patients, a shorter duration of treatment with eptifibatide may prevent the ischemic complications of percutaneous coronary intervention.
Cholestyramine Ointment Used on an Infant for Severe Buttocks Rash Resistant to Standard Therapeutic Modalities
Authors: White C Michael , Kalus James S , Caron Michael F , Suski Kelly
Published: September 2013

Objective:

To describe a case of severe buttocks rash refractory to standard therapy that was treated successfully with cholestyramine 5% in Aquaphor.

Case Summary:

An infant developed a rash that worsened to a severe and very painful buttocks rash refractory to other therapies. When cholestyramine ointment was applied after every stooling, the rash was markedly improved within 2 days and completely resolved 7 days after therapy was initiated.

Discussion:

Fecal expulsion of bile acids may be the reason for treatment-refractory severe buttocks rashes in infants. The use of topical cholestyramine ointment may lead to the resolution of problems even among previously determined treatment-refractory cases. This was shown elsewhere in a child on a promotility drug.

Conclusions:

Cholestyramine ointment can be compounded and may provide benefit for infants who have a severe buttocks rash that is refractory to traditional therapies.
Phenelzine–Opiate–Induced Delirium Complicated by Phenelzine Withdrawal
Authors: Gold Douglas G , Fatemi S Hossein
Published: September 2013

Objective:

To report a case of delirium involving a drug interaction of the antidepressant phenelzine in combination with an opiate and to discuss the exacerbation of delirium secondary to a withdrawal syndrome caused by the abrupt discontinuation of phenelzine.

Case Summary:

A 67-year-old white woman with a history of major depression and chronic anxiety developed delirium shortly after the postsurgical administration of opioid analgesics. In addition, she was taking the antidepressant phenelzine and had been maintained on this medication for approximately 20 years. Her presenting symptoms included combativeness, auditory and visual hallucinations, and persecutory delusions. After development of the delirium, the patient's phenelzine medication was abruptly discontinued, introducing a withdrawal syndrome that further aggravated her condition.

Discussion:

This case emphasizes the importance of the potentially fatal drug interaction involving phenelzine and opiates and addresses the adverse consequences of abruptly discontinuing phenelzine during phenelzine–opiate–induced delirium. Phenelzine–opiate interactions and phenelzine withdrawal should be considered as possible etiologies of delirium in patients with a history of phenelzine use.

Conclusions:

Less widely prescribed antidepressants such as phenelzine may be unfamiliar to contemporary clinicians, resulting in adverse consequences for patients, such as phenelzine–opiate drug interactions and phenelzine withdrawal.
Seizures: An Unusual Complication of Intrapleural Povidone–Iodine Irrigation
Authors: Azzam Zaher S , Farhat Diab , Braun Eyal , Krivoy Norberto
Published: September 2013

Objective:

To report a case of seizures that probably developed because of the disinfectant and antiseptic agent povidone iodine (PVI).

Case Summary:

A 67-year-old healthy white man developed pleural empyema that was treated with drainage and intrapleural PVI irrigation. Within 10 minutes, complex partial seizures with secondary generalization lasting several minutes were documented. Several hours later, the patient developed a similar episode. Both events resolved spontaneously and, in 10 months of follow-up, there was no recurrence.

Discussion:

The adverse effects of iodine are known; however, little has been reported about seizures following the administration of PVI. This complication is thought to be due to either the osmotic and hydrophilic qualities or the presence of ionic changes and lipid solubility of PVI.

Conclusions:

Intracavitary PVI should be considered in the differential diagnosis of localized and generalized seizures.
Voriconazole: A Novel Antifungal
Authors: Gunderson Shana M , Jain Rupali , Danziger Larry H
Published: September 2013

Objective:

To review the published in vitro, in vivo, and clinical data and FDA background documents that led to the approval of voriconazole.

Data Sources:

Articles were identified by the referenced package insert and by a MEDLINE search (1966–October 2002) using the terms voriconazole, azole antifungal, aspergillosis, and UK-109, 496. Additionally, journal Web sites and abstracts from major infectious disease meetings were researched to obtain newly published data.

Study Selection:

All animal and human data published in journals, abstracts, and FDA background documentation were used. The only in vitro susceptibility testing studies used were those that incorporated a large number of fungal isolates.

Data Synthesis:

Voriconazole is a novel monotriazole antifungal agent that inhibits the fungal cytochrome P450–mediated 14 α-lanosterol demethylation. In vitro susceptibility studies, in vivo clinical trials, and case reports have shown potent activity against various Aspergillus spp., Scedosporium, and Fusarium. Additionally, voriconazole has shown in vitro activity against dimorphic fungi and yeast, including Candida spp. and Cryptococcus neoformans. The efficacy of voriconazole has been evaluated in 4 clinical trials. The clinical studies indicate that it is at least as effective as amphotericin B for the treatment of acute invasive aspergillus infection. The most common adverse effects in clinical trials included visual disturbances, rash, and elevated liver function tests. Voriconazole is metabolized by CYP2C19, CYP2C9, and CYP3A4 and thus causes multiple serious drug–drug interactions.

Conclusions:

Voriconazole provides an advance in therapy for the treatment of acute invasive aspergillus infection.
Rhabdomyolysis Due to Combined Therapy with Cerivastatin and Diclofenac
Authors: Schechner Vered , Hershcovici Tiberiu , Beigel Yitzhak
Published: September 2013

Objective:

To describe the occurrence of severe rhabdomyolysis and acute renal failure in a patient treated concomitantly with cerivastatin and diclofenac.

Case Summary:

A 73-year-old white man with mild chronic renal failure, treated with cerivastatin for hypercholesterolemia, received intramuscular injections of diclofenac for low-back pain. A few days later, severe muscle weakness and acute renal failure developed. Laboratory tests confirmed severe rhabdomyolysis. Diclofenac and cerivastatin were discontinued, and treatment with forced diuresis and urine alkalinization was started. Twenty-four days later, serum creatine phosphokinase and urinary function returned to baseline, and the muscle weakness improved.

Discussion:

Rhabdomyolysis is a well-known adverse effect of statins. According to recent reports, it occurs more frequently with cerivastatin than with other statins. Nevertheless, the interaction between cerivastatin (or other statins) and diclofenac as a trigger for rhabdomyolysis has never been reported.

Conclusions:

Coadministration of diclofenac (and perhaps other nonsteroidal antiinflammatory drugs) with cerivastatin (and perhaps other statins) should be done cautiously, especially in the presence of renal failure, under close monitoring of renal function and muscle enzyme levels.
An Unusual Case of Thrombocytopenia and Leukopenia Associated with Diltiazem and Acyclovir
Authors: Cersosimo Robert J , Hankins Michelle A , Hamrah Sanaz D
Published: September 2013

Objective:

To describe the case of a patient who developed thrombocytopenia associated with diltiazem and leukopenia associated with diltiazem or acyclovir.

Case Summary:

An 81-year-old white man was admitted for management of chronic obstructive pulmonary disease (COPD). On admission, his white blood cell (WBC) count and platelet count were within normal limits. Admission medications included metoprolol, which was replaced on day 3 with diltiazem due to concern that it might exacerbate the COPD. The patient's platelet count at the initiation of diltiazem therapy was 180 × 103/mm3. The next day the platelet count was 232 × 103/mm3, but decreased to 182 × 103/mm3 on day 5 and continued to decline through day 30, at which time it reached a nadir of 10 × 103/mm3. By then, several causes of thrombocytopenia, including disseminated intravascular coagulation and thrombotic thrombocytopenic purpura, had been ruled out. A hematology consult suggested diltiazem as the cause of thrombocytopenia, and it was discontinued. The platelet count began to rise 8 days after discontinuation of diltiazem and returned to normal values over a period of 5 days. On day 15, acyclovir was initiated for an oral herpes simplex virus–1 infection. The WBC count on day 20 was 8.7 × 103/mm3, and it continued to decline daily. On day 24, the value was 2.5 × 103/mm3, at which time acyclovir was discontinued. The WBC count continued to decline for 6 days, reaching a nadir of 0.6 × 103/mm3, at which point filgrastim was initiated; the WBC count gradually returned to normal over the next 5 days.

Conclusions:

Myelosuppression is a rare complication of diltiazem and acyclovir therapy. Patients using these medications should be monitored for signs and symptoms of myelosuppression.
Possible Lovastatin-Induced Fatal Necrotizing Pancreatitis
Authors: de A Nishioka Sérgio , Guedes Liliane Q
Published: September 2013

Background:

A few cases of statin-associated pancreatitis have been reported in the literature, mostly related to the use of simvastatin. Only 3 cases of pancreatitis associated with lovastatin have been recognized, with 2 of them possibly due to its interaction with gemfibrozil and erythromycin.

Case Report:

A 49-year-old woman, who had been receiving treatment for hypercholesterolemia with lovastatin 20 mg/d for about a month, was admitted to a hospital with a diagnosis of diarrhea and septic shock. She was later referred to another hospital where surgical diagnosis of necrotizing pancreatitis was made and died after prolonged hospitalization. This patient had no evidence of common risk factors to acute pancreatitis, such as biliary tract disease or alcohol use, but had moderate hyperlipidemia. Assessment of the likelihood of a causal relationship using the Naranjo probability scale suggested that the association between lovastatin and necrotizing pancreatitis in this case was probable or possible, depending on the rejection or acceptance of shock or use of ranitidine and ceftriaxone as alternative causes of pancreatitis.

Discussion:

There is some evidence that statins are rarely associated with acute edematous and necrotizing pancreatitis, by unknown mechanisms. This case report adds to the evidence that lovastatin is possibly 1 of such statins.

Conclusions:

Lovastatin is a possible cause of pancreatitis. Prescribers of statins (particularly simvastatin and lovastatin) should take into account the possibility of acute pancreatitis in patients who develop abdominal pain within the first weeks of treatment with these drugs.