bluuebunny/crossref_metadata_2025 huggingface dataset:
Virius Nicomachus Flavianus, Der Praefectus und Consul des Carmen contra paganos
Authors: Coşkun Altay
Published: June 2004

After a general caveat concerning the interpretation of polemical pamphlets, various chronologically relevant aspects of the so-called Carmen contra paganos are revisited. In particular, the recent identification of the anonymous praefectus and consul with Vettius Agorius Praetextatus is challenged by reasserting the classical identification with Virius Nicomachus Flavianus. Thus the composition of the poem can be dated to the aftermath of the battle at the Frigidus (5-6/9/394) on firm grounds. At the same time, new light can be shed on the careers of Leucadius rationalis rei privatae fundorum domus divinae per Africam ca. 388/90 and Marcianus proconsul Campaniae ca. 393/94. This way, the author's methods of distorting as well as various modern misconceptions emerge. As a conclusion, some new paths of further research on the poem and on late Roman religious conflicts can be suggested.
Blackadder Bites Back
Authors: Riddell Mary
Published: June 2004

Mary Riddell meets former Press Complains Commission director and, later, Prince of Wales' spin doctor, and reports; "For a PR genius, he was rather coy about being interviewed." She also reveals that Bolland believes his successors have served the Prince badly, or foolishly. "Nor does Charles himself come in for undue veneration," she writes. "Bolland, who described him as 'weak' in his only previous interview, says now that Charles had his chance of marrying Camilla and missed it. Though none of his remarks are delivered with a sliver of malice, it must sometimes seem to his critics at the Palace that Bolland in exile is even worse than Bolland in situ."
And Finally? Not Quite Yet
Authors: Purvis Stewart
Published: June 2004

The former chief executive of ITN looks at the future of the most-watched television news in history, examines its current predicaments and observes: "The obituaries for ITN may be a little premature, although I suspect the race between survival and oblivion will be a darned close run thing. If it does turn out to be the end, the spirit of ITN and the memory of the many extraordinary things it has achieved over 50 years will, I am sure, continue in the various successor newsrooms and also in the many executive offices at Sky News and BBC News now occupied by former ITN staff. And the pensioners in the ITN 1955 Club will still meet up regularly to re-live past glories and complain even more about how things are definitely not what they used to be."
Why Women Love Journalism
Authors: Day Elizabeth
Published: June 2004

Elizabeth Day was one of five women among the six finalists when elected Young Journalist of the Year at the British Press Awards earlier this year. Here she describes her love affair with print journalism and observes: "None of the other, more established, awards had the same shortlist composition, suggesting that a new generation of women journalists is beginning to edge into the public consciousness. Now, more than ever, it seems that the future of journalism is female." She puts this down to the increase in celebrity journalism: "Who better to infiltrate this fast-paced world than a glamorous young woman, with the intelligence to use her feminine wiles? Celebrity gossip is a more extreme aspect of diary schmoozing and a watered-down version of the honey-trap. In both, women are able to capitalise on their assets to get a good story. Given that the readership of the gossip pages is mostly female, it also makes sense to employ women who know what other women want."
Local Heroes
Authors: Pecke Samuel
Published: June 2004

Under the pseudonym of the 17th century journalist who entered the trade because it paid considerably more than the 15 shillings-a-week he earned as a scrivener, a London weekly newspaper trainee describes the disappointments of working in local journalism. "A completely unscientific poll of friends on other local newspapers suggested I was not alone in my fears," he writes. "Most admitted what they put out week after week was simply not as good as it should be. And the reason? The endemic weaknesses in the way their newsrooms and companies were run. All pointed to the age-old problems of low pay, poor working conditions, the complete absence of training, long hours, understaffed newsrooms and a managerial emphasis on quantity rather than quality." This devastating article is a salutary warning for the newspaper industry.
The Jazzman Cometh
Authors: Melly George
Published: June 2004

Writer and jazz singer Melly pays tribute to the artist and clarinetist, creator of the Flook strip cartoon and, now, prizewinning political cartoonist of The Sunday Telegraph. Melly, who for 14 years wrote the scripts for Flook, recalls: "What was true, and all the other scriptwriters both before and after me will confirm it, is that working for Wally is no picnic. He is a perfectionist. We'd meet once a week in the art editor's office and I'd hand Wally what I'd written. He'd read it slowly, giving no clue as to his reaction, and then pass judgement. Praise, being rare, was lapped up, acceptance was a relief, but rejection was intensely dispiriting. "Good two days there," he'd tell me when I'd written eight. He would also reproach me for writing too much, claiming I'd only left him enough space for drawing in the tips of Flook's ears."
Surviving in the Hackademy
Authors: Errigo Jackie , Franklin Bob
Published: June 2004

Two journalist-academics suggest that, judging by the experiences of some rather research-battle-weary delegates at a recent conference of the Association for Journalism Education, it can be an uphill struggle to persuade the university to consider journalism research as suitable for the Research Assessment Exercise. "If journalism courses and hackademics are to flourish," they write, "it is important to balance delivering a quality professional education with publishing scholarly research - the latter generally being viewed as the route to promotion and career advancement... Despite the obstacles, we are certain that academic life demands scholarship from everyone. Teaching is a privilege and a pleasure and, we believe, so is research."
Top People Write to the Times
Authors: Wober J M
Published: June 2004

Author and media studies lecturer Wober has conducted surveys of the Readers' Letters pages of the national newspapers and concludes that, despite its changing editorial profile, The Times is still the top people's newspaper when it comes to correspondence. He writes: "Just how significant is the main correspondence page in The Times? The answer lies partly in examining other such pages. The tabloid newspapers carry much smaller letters sections (if any at all) and include very few elite contributors. Quite simply, a letter in the Daily Express, Mail or Mirror, even on a serious matter, is unlikely to be seen by legislators or civil servants. Among the broadsheets that offer serious journalism, The Independent and Guardian each have less than half the circulation of The Times, so even if they attract a substantial elite readership, and letters from those within it, the results do not reach such a large section of the public... This leaves the right-wing Telegraph, with a considerably higher circulation than The Times -; yet examination of several copies suggests that The Times' more centrist political standpoint attracts a wider spectrum of influential correspondents."
Still on the Waterfront
Authors: Hagerty Bill
Published: June 2004

One of the world's great boxing writers and Oscar-winning screenwriter talks about the fight game, growing up in Hollywood, F. Scott Fitzgerald, with whom he collaborated on a movie script, and how his first novel, What Makes Sammy Run?, gave him his professional freedom: "I started to realise that I could make a living writing short stories in the Saturday Evening Post and Esquire. I was married also, but knew I wouldn't have to rely upon Hollywood for a living. My father had said to me when he read the manuscript of Sammy, 'After they read this book, you'll never be allowed back here again. How are you going to live?' He couldn't picture how I would survive. So the short story writing was a way out, because they were paying pretty well and I started making a thousand bucks a piece. It may not have been what Scott Fitzgerald was getting, but at that time, in 1938, a thousand bucks was very good money."
Managing the Clinical Consequences of Psychiatric Illness and Antipsychotic Treatment: A Discussion of Obesity, Diabetes, and Hyperprolactinemia
Authors: Vreeland Betty , Kim Edward
Published: June 2004

Many individuals who suffer from serious and persistent mental illness also have co-occurring physical problems that are frequently misdiagnosed, underdiagnosed, or undertreated. Tragically, this population loses between 8 and 20 years of life expectancy when compared to a nonpsychiatric population. Hyperglycemia, diabetes, and weight gain have long been established as correlating with mental illness and psychotropic medications, leaving it difficult to identify which condition came first. Hyperprolactinemia is an additional consequence of select antipsychotic therapies that results in endocrine and sexual disturbances. Clinicians need to understand how to assess and manage the health risks associated with psychiatric conditions and their treatments. The psychiatric nurse is a key member of the health care team whose holistic framework can afford an opportunity to bridge the gap between mental and physical health. This article discusses the overall assessment and management of psychotropic-associated weight gain, obesity, type 2 diabetes, and hyperprolactinemia in patients with schizophrenia and bipolar disorder.
Demystifying the Disease State: Understanding Diagnosis and Treatment Across the Bipolar Spectrum
Authors: Lewis Frederick T.
Published: June 2004

It is estimated that only one-third of the people with bipolar disorder are correctly diagnosed, and even fewer are receiving appropriate treatment. This information is of concern, particularly in light of emerging data reflecting the potential negative consequences of failed or delayed diagnosis and lack of focused treatment. The article attempts to illuminate this complex disorder by describing the bipolar spectrum through a review of the criteria for diagnosis, aswell as practical advice on improving the detection of the disorder. Treatment options for bipolar disorder, with a focus on the latest pharmacological evidence base, as well as clinical recommendations regarding the safe and effective use of mood stabilizers and antidepressants are presented.
Steiner’s Possession
Authors: Hutchinson Phil
Published: June 2004

Since the resurgence of interest in political philosophy in the early 1970s debates about freedom have been central. Throughout this period Hillel Steiner has proposed and defended the pure negative conception of freedom. This work is complemented by Ian Carter’s recent writings on freedom. Carter and Steiner advance a non-normative (empirical) conception of freedom employing tools from contemporary philosophy of action and language. In this article I seek to offer a deflationary critique of the Carter/Steiner position. My purpose is not to deny the potential moral or political significance of a pure negative conception of freedom but rather to deflate the philosophical foundations claimed for such a conception. I show Steiner’s commitment to the pure negative conception of freedom is a substantive moral commitment, not the result of logical conclusions deemed from conceptual analysis.
Jürgen Habermas
Authors: Turner Charles
Published: June 2004

Habermas’s recent writings on the future of Europe advocate a European constitution as a means of consolidating the achievements of post-war social democracy and providing European level institutions with a normative foundation without the need to appeal to the idea of Europe as a ‘community of fate’. This article argues that, while these aims are laudable, the terms in which Habermas formulates them owe much both to a domestic German agenda and to his theory of communicative rationality and the public sphere, which restricts the horizon within which the legitimacy of a European polity might be discussed and entails premature assumptions about what the core of a European identity consists in. It ends by suggesting an alternative sense of the European achievement and European identity.
Constitution Making and Democratic Innovation
Authors: Bohman James
Published: June 2004

The European Union stands before a constitutional moment. While some deny the need for a constitution and others want a familiar federal form, I argue that one of the main goals of the constitutional convention ought to be to make the European Union more democratic. The central question is: what sort of democracy is suggested by some of the more novel aspects of European integration? This question demands a normative standard by which to evaluate the realization of democracy in transnational polities. Along republican lines, the proper standard is nondomination. With this normative framework in mind, the problem that the constitution has to solve is juridification, or the possibility of legal domination where there is no unified sovereignty. The solution to this problem of legal domination requires that the constitution institute a reflexive legal order best realized in a deliberative federalism appropriate to a polycentric and diverse polity. Finally, the institutions of this federalism ought also to be characterized through their distinctive form of inquiry, which, borrowing from Gerald Ruggie, I call ‘multiperspectival’. In a transnational polity with multiple demoi, such a democracy is best realized through dispersed and plural forms of authority and in a differentiated institutional structure anchored in a reflexive constitution.
Numerical simulations of ductile regime machining of silicon nitride using the Drucker-Prager material model
Authors: Ajjarapu S K , Patten J A , Cherukuri H , Brand C
Published: June 2004

Recent studies have shown that many semiconductor and ceramic materials can be machined in ductile fashion under high pressures and at low depths of cut. In a previous study, the authors reported results from numerical simulations of the orthogonal machining of silicon nitride using a pressure independent material model with the von Mises yield criterion. In the present work, the mechanical behaviour of silicon nitride is treated using the Drucker-Prager yield criterion implemented in the commercial machining software AdvantEdge. Numerical simulations are carried out for depths of cut ranging from 1 to 40 μm and at cutting speeds ranging from 25 to 300 m/min. Results from the simulations are presented, and modelling issues are discussed.
Cyclic microindentations on monocrystalline silicon in air and in water
Authors: Zarudi I , Zhang L C , Swain M V
Published: June 2004

This paper studies the difference in the mechanical response of monocrystalline silicon to cyclic microindentations in air and in water. It shows that in air the indentations with a spherical indenter generated consequent phase transformations. In the first indentation cycle, the decomposition featured amorphous phase at low maximum indentation load, Pmax, that was converged to a crystalline compound in repeated indentations. A high Pmax generated crystalline R8/BC8 phases only. After a few cycles, the transformed material behaved linearly elastically, and its properties became stable. However, when the same indentations were conducted in water, the property stabilization process of the transformed material was significantly slowed down, featuring non-linear elasticity. It seemed that at a high Pmax a chemical effect took place in the central part of the transformation zone.
Molecular dynamics study on interfaces generated between atomic clusters
Authors: Saitoh K-i
Published: June 2004

The atomic structure of grain boundaries generated in the process of coalescence between copper atom clusters is investigated using the molecular dynamics method. The effective medium theory is adopted as interatomic interaction for precise estimation of surface and defect energies. The effect of cluster size, velocity and crystalline orientation on the atomic behaviour are studied. When cluster size is relatively small, dislocations (detected as stacking faults) generated in the contact region develop throughout the cluster body. On the other hand, in larger-size clusters, stacking faults are multiple and they interact with each other inside clusters. The local atomic structure is effectively assessed by a topological method, by which atoms are recognized as a face-centred cubic (fcc) structure or a hexagonal close-packed (hcp) structure. Large approaching velocity results in a flattened shape of clusters and induces complicated propagation of stacking faults, where the critical speed for this transition is estimated at 600–700m/s approximately. When a slight orientation angle is applied to clusters, the difference in angle is cancelled by the spontaneous spin of clusters. However, when a large orientation mismatch is given to clusters, nucleation and growth of stacking faults are obstructed according to the Schmid factor of slip.
Rate-dependent shear deformation of ductile acrylic adhesive and its constitutive modelling
Authors: Takiguchi M , Izumi S , Yoshida F
Published: June 2004

Recently, new types of structural adhesive with high ductility, as well as high strength, have been developed and put on the market. Such high ductile adhesives usually have strong rate sensitivity in their flow stress. In order to investigate the rate-dependent deformation behaviour of an acrylic adhesive, tensile lap shear tests were performed at various crosshead speeds at room temperature. Stress relaxation tests were also performed. In the tensile lap shear tests, it was found that the shear flow stress of the adhesive resin increased remarkably with increasing shearing speed. In the stress relaxation tests, the stress decreased rapidly at the early stage, and it gradually approached an asymptotic stress value. In order to describe such rate-dependent deformation characteristics of adhesive resin, a viscoplastic constitutive model is presented in this paper. The shear stress-strain responses, as well as stress relaxation behaviour, predicted by the present model agree well with the corresponding experimental results.
A rolling-annealing cycle for enhanced deep drawing properties in interstitial free steels
Authors: Quadir M Z , Lam K T , Duggan B J
Published: June 2004

To give good drawability, steel needs high volume fractions of the annealing texture component {111} 〈hkl〉 and a low fraction of ε {100} 〈0k1〉. This is achieved in conventional Nb + Ti stabilized interstitial free (IF) steels by a cold rolling (CR) reduction of 85 per cent followed by annealing at 750–850°C for a few minutes. In this research, a detailed investigation of two-stage deformation processes was undertaken in which the total reduction in thickness was kept constant at 80 per cent, with a first and second rolling interrupted by recrystallization (RX) before the final recrystallization anneal was made. The texture produced is a rather flat γ recrystallization fibre of relatively high intensity at a reasonable final grain size. A second experiment, involving rolling ferrite at 700°C, produced a strong rolling texture and a well-developed {111} 〈hkl〉 texture after annealing at 710°C, and so this material was also subjected to further rolling and annealing. The intermediate annealing between warm rolling (WR) and subsequent cold rolling significantly improved the intensity and uniformity of the final {111} texture compared with metal that was cold rolled without intermediate annealing. An investigation into the mechanisms involved in recrystallization revealed that the {111} 〈hkl〉 oriented grains were subject to orientation splitting involving rotations around 〈111〉 ND, and this process of deformation banding produced the necessary lattice curvature for nucleation of the {111} recrystallization texture components essential for good deep drawability.
Spatial free plastic forming of slender parts—numerical approaches for strain-hardening material
Authors: Thalmair M , Lippmann H
Published: June 2004

A new metal forming process is described in which a slender part may be brought to a prescribed final shape by means of an appropriate, pre-calculated motion of its free ends only. Corresponding calculation schemes are presented for elastic/plastic material with strain hardening, and these are illustrated by practical examples.
Prediction of spring-back in anisotropic sheet metals
Authors: Nguyen V T , Chen Z , Thomson P F
Published: June 2004

Constitutive equations for plane stress problems based on the modified form of a non-quadratic yield criterion suitable for aluminium alloy sheet were derived by Barlat et al. to account for the Bauschinger effect (BE). Numerical predictions of spring-back based on the original yield function and its modified form wer performed and compared with the results of draw-bending tests. The results show the necessity of including the BE in the constitutive equations to enhance the accuracy in predicting spring-back.
High-pressure and high-temperature powder diffraction on molybdenum diphosphide, MoP2
Authors: Soto Victor , Knorr Karsten , Ehm Lars , Baehtz Carsten , Winkler Björn , Avalos-Borja Miguel
Published: June 2004

The isothermal compressibility and bulk thermal expansion of molybdenum diphosphide, MoP2, were measured by in-situ X-ray powder diffraction from ambient conditions to 6.8 GPa and 839 K, respectively. A small anisotropy of the compressibilities in MoP2 appears to be governed by non-bonding interactions in this layer-like material. The thermal expansion data are compared to molybdenum phosphide, MoP, which was measured to 1262 K.
The effects of pressure, temperature and composition on the crystal structures ofα-quartz homeotypes
Authors: Haines Julien , Cambon Olivier
Published: June 2004

α-Quartz and its homeotypes are of great importance for both materials and Earth sciences. The properties of these materials depend strongly on their crystal structures and particularly the intertetrahedral bridging angle and the tetrahedral tilt angle. These angles are highly dependent on composition and the external parameters pressure and temperature. The behavior of the eleven knownα-quartz homeotypes, along with examples ofα-quartz-type solid solutions, are compared. The distortion inα-quartz-type structures decreases as a function of temperature and increases as a function of pressure. Thermal stability depends on initial structural distortion and on the electronic configuration of the cation. Pressure stability also depends on the former and on cation size. Transitions to new crystalline and/or amorphous forms, often with increased cation coordination number, are commonly observed at high-pressure. The combined use of high-pressure and high-temperature can be used to synthesize novelα-quartz homeotypes in compounds with small cations.
Multianvil high-pressure / high-temperature synthesis in solid state chemistry
Authors: Huppertz Hubert
Published: June 2004

During the last 60 years, new high pressure techniques and their exploitation have permitted the extension of attainable pressure/volume conditions, increased versatility of the apparatus, and hydrostaticity of the attained pressure in a remarkable way. In preparative solid state chemistry, high-pressure/high-temperature synthesis always played a minor role due to technical difficulties and costs. Piston-cylinder and Belt-apparatus both were limited to the working range up to 3 and 10 GPa, respectively. New technical developments, which allow synthesis up to 25 GPa, open up an enormous field of sample synthesis in solid state chemistry. In the following, a short overview on the most important developments in multianvil-techniques is given with respect to their applications for solid state chemistry under high-pressure conditions.
Putting the squeeze on NaCl: modelling and simulation of the pressure driven B1-B2 phase transition
Authors: Leoni Stefano , Zahn Dirk
Published: June 2004

We used a geometric approach to derive models for the transition B1 (NaCl) to B2 (CsCl) type structure. This enabled us to construct several dynamical transition states, corresponding to different mechanistic pathways. From this, transition trajectories were obtained, which served as starting points for path sampling molecular dynamics simulations. We point out the difference of this approach from approaches based on energy calculations, and demonstrate that a preferred mechanism can be clearly discriminated.
Ab initio investigations of TlI-type compounds under high pressure
Authors: Becker Daniel , Beck Horst P.
Published: June 2004

In this work, we present a theoretical study (based on DFT-calculations) in a wide pressure range of the structural and electronic properties and the stability of compounds crystallising in a TlI- or CrB-type structure. Both structure types have the characteristic structural feature of zigzag chains with unusual short homonuclear distances. The main focus of this study is to elucidate the nature of bonding within these zigzag chains at ambient and elevated pressure. For this purpose we discuss the evolution of the distances within the zigzag chains with pressure, the transition pressure of the phase transition to a CsCl-type arrangement (high-pressure phase) and compressibilities of the low- and high-pressure phases. For a better understanding of the structure and bonding, the band structures of these compounds are evaluated. The calculations are complemented by an orbital analysis using the crystal orbital Hamilton population (COHP) and an analysis of the electronic density topology with the electron localisation function (ELF). Our study indicates that there is a bonding electron pair in compounds crystallising in the CrB-type structure and that the nature of the electron pair does not change significantly at elevated pressure up to the phase transition. However, the “character” of the additional electron pair in the In-monohalides (TlI-type structure) changes with increasing pressure from nonbonding to bonding. The phase transition to a CsCl- type structure implies a fundamental change to nonbonding stereochemically inert electron pairs for all compounds.
Polymorphic forms of Rb2Te: in-situ high-pressure DAC X-ray diffraction investigations and structure modelling with CASTEP
Authors: Stöwe Klaus
Published: June 2004

We report on high pressure X-ray diffraction investigations of Rb2Te in diamond anvil cells DAC (Mo Kα

1 radiation, Rietveld refinement of the diffraction diagrams), which resulted in a polymorphic transformation series for the compound Rb2Te from an anti-fluorite type into an anti-cotunnite type (transition pressure 0.5 GPa) and further on into a Ni2In type structure (transition pressure 1.5 GPa). Among the compounds of the composition A2B Rb2Te has up to now an exceptional position in so far, as this sequence of polymorphic forms is also observed as a high-temperature transformation series. Geometry optimizations on the basis of DFT calculations with the program CASTEP confirmed the phase transitions observed experimentally. Since the anti-cotunnite and the Ni2In type are structurally related — between both structure types there is a group-subgroup relation with the Ni2In type as aristo-type (1st Landau criterion) — the transition between the two types can be characterized as continuous in real space coordinates. According to experimental data as well as results of the CASTEP calculations the phase transition takes place with a discontinuity in the volume versus pressure curve. The geometry optimizations give direct insight in the continuous mechanism of the transition and offer the possibility to compare intermediate structural arrangements with other structures to be discussed in this context, as e.g. the post-cotunnite or the Co2Si structure-type.
Electronic structure and bonding in antimony and its high pressure phases
Authors: Ormeci Alim , Rosner Helge
Published: June 2004

The effects of pressure on the electronic structure and on the bonding properties of Sb are studied by first-principles electronic structure methods. A commensurate approximate structure is used in the calculations for the modulated incommensurate Sb-II phase. It is found that the overlap of s and p bands increases with increasing pressure resulting in pressure-induced metallization of Sb. Analyses based on the electron localization function show that there is no chemical bond between the chain atoms of a previously suggested Sb-II structure. The high total energy of this structure with respect to other structures considered is a result of the absence of this binding.
Duration of Penicillin Prophylaxis in Sickle Cell Anemia: Issues and Controversies
Authors: Pai Vinita B. , Nahata Milap C.
Published: June 2004

Functional asplenia occurs in 94% of patients with homozygous sickle cell anemia by 5 years of age and may result in fatal septicemia due to encapsulated microorganisms such as Streptococcus pneumoniae. Penicillin prophylaxis in these patients significantly reduces the risk of septicemia; however, continuation of prophylaxis beyond 5 years of age is controversial, since the risk of developing septicemia is reduced after this age and prolonged prophylaxis may lead to emergence of penicillin resistance. Although reports of penicillin‐resistant pneumococci in patients receiving penicillin prophylaxis are conflicting, the prevalence of these organisms in the general population in North America increased from 5% in 1989 to more than 35% in 1997. Discontinuation of prophylaxis after age 5 years may be recommended because of lack of benefit, difficulty maintaining compliance, reduced risk of developing pneumococcal bacteremia after that age, and increase in prevalence of penicillin‐resistant pneumococci worldwide.
HIV‐Associated Lipodystrophy Syndrome
Authors: Qaqish Roula B. , Fisher Evelyn , Rublein John , Wohl David A.
Published: June 2004

Highly active antiretroviral therapy (HAART) for human immunodeficiency virus‐1 (HIV‐1) and prophylactic therapy for opportunistic infections have increased survival. Adverse effects of HAART include lipid profile alterations, diabetes mellitus, and fat redistribution. These metabolic and physical changes are called the HIV‐associated lipodystrophy syndrome. A link to protease inhibitors has been suggested, and more recently to nucleoside reverse transcriptase inhibitors and factors related to duration of HIV‐1 infection itself.
Antipsychotic Agents in Patients with Dementia
Authors: Defilippi Jennifer L. , Crismon M. Lynn
Published: June 2004

We conducted a MEDLINE search to obtain data on various antipsychotics administered to patients with dementia and psychosis or behavioral symptoms. Additional unpublished data from conference proceedings and unpublished clinical trials were provided by Janssen Pharmaceutica, Eli Lilly and Company, and Zeneca Pharmaceuticals. All clinical trials that evaluated traditional typical or atypical antipsychotics in patients with dementia were reviewed for efficacy and safety data. Consensus guidelines published in 1994 or later were considered. After reviewing clinical trials and expert opinions, we devised an algorithm for optimal treatment of these patients. Although data are limited and do not conclusively show superiority of one agent over another, based on clinical experience and side effect profiles, risperidone is considered to be the drug of choice for treating patients with dementia and psychosis. Alternative treatment options in an algorithmic format also are recommended.
Helicobacter pylori, Chlamydia pneumoniae, and Cytomegalovirus: Chronic Infections and Coronary Heart Disease
Authors: Wierzbicki W. Barbara , Hagmeyer Kathleen O.
Published: June 2004

We conducted a MEDLINE search of the English‐language literature from 1966–1999 on the association of chronic infections with Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus (CMV) with coronary heart disease (CHD); additional literature was retrieved from references of selected articles. All human studies were included. Abstracts were excluded because of limited data. Chronic infections in CHD are speculated to be due to serum antibody concentrations of one or more of the three organisms. Data for H. pylori and CMV are difficult to interpret due to the confounding factor of childhood poverty and studies conducted in transplant recipients, respectively. Chlamydia pneumoniae data appear stronger with elevated IgG antibody titers (≥ 64) as a risk factor. Larger prospective studies are warranted to determine an association with CHD before universal prophylaxis or treatment of these chronic infections.
Frequency, Severity, and Treatment of Agitation in Young versus Elderly Patients in the ICU
Authors: Fraser Gilles L. , Prato B. Stephen , Riker Richard R. , Berthiaume Donald , Wilkins Micheline L.
Published: June 2004

Study Objective. To study the frequency, duration, severity, and treatment of agitation in patients in the intensive care unit (ICU) to determine if the elderly represent a distinct population.

Design. Prospective cohort study.

Setting. Tertiary care, 10‐bed, multidisciplinary ICU.

Patients. All patients older than 18 years of age admitted for longer than 24 hours during a 4‐month period.

Interventions. None.

Measurements and Main Results. One hundred thirty patients were studied for 916 patient‐days; 63 (48%) were elderly (> 65 yrs). Nurses and physicians described agitated behavior in 92 patients (70.8%) during 534 (58.3%) patient‐days, and it was severe or dangerous in 60 patients (46.1%) during 273 (30%) patient‐days. There were no age‐related differences in frequency, severity, and duration of agitation. Opiates, benzodiazepines, and haloperidol were administered during 72%, 62%, and 29% of agitated patient‐days, respectively. Haloperidol was administered more often to elderly patients (p=0.015); otherwise no between‐group differences were noted. Daily dosing requirements were less in the elderly for intermittent intravenous lorazepam, haloperidol, and morphine but not for midazolam (p=0.15). When these dosages were corrected for body mass, no statistical differences between young and old were found.

Conclusion. In the ICU, the elderly are not a distinct population for agitation.
Intravenous Valproate in Neuropsychiatry
Authors: Norton John W. , Quarles Emily
Published: June 2004

Valproic acid (VPA) is administered for a variety of indications in neurology and psychiatry. The intravenous form of VPA, valproate, has been used extensively by neurologists since the 1980s for patients with status epilepticus, as serum levels can be achieved rapidly and telemetry is not required during administration. Psychiatrists have less experience with intravenous valproate, and little is documented in the literature regarding its nonepileptic indications. Patients who are unable or unwilling to take drugs orally, or for whom rapid treatment is clinically indicated, may benefit from VPA. Neuroleptics and benzodiazepines often are given parenterally; however, they may be accompanied by side effects. Intravenous valproate was administered successfully to three patients with neuropsychiatric disorders. It is hoped that this report will increase clinicians' awareness of this important and well‐tolerated treatment option.
Decreased Methadone Effect after Ritonavir Initiation
Authors: Geletko Sandra M. , Erickson Allan D.
Published: June 2004

Combination antiretroviral therapy including protease inhibitors such as ritonavir has added significant potency to therapy for human immunodeficiency viral (HIV) infection as well as substantial drug‐drug interactions. Methadone metabolism is affected by cytochrome P450 (CYP) 3A4 inhibitors or inducers. Because ritonavir can induce CYP3A, it can decrease methadone plasma levels. An HIV‐infected patient receiving methadone maintenance experienced withdrawal symptoms after ritonavir, saquinavir, and stavudine were added to his regimen; the most likely cause was ritonavir.
Possible Drug‐Associated Pancreatitis after Paclitaxel‐Cremophor Administration
Authors: Mills Kimberly M. , Johnson Deborah M. , Middlebrooks Mark , Burton Gary V.
Published: June 2004

Paclitaxel, a relatively new antineoplastic agent, is associated with numerous side effects, including two reported cases of pancreatitis. Our patient also developed paclitaxel‐associated pancreatitis. Several companion drugs, including steroids, diphenhydramine, histamine2 blockers, serotonin type 3 antagonists, and other chemotherapeutic agents administered with paclitaxel, must be considered as possible causes of pancreatitis. In addition, paclitaxel is a hydrophobic agent that requires a vehicle, cremophor (CrEL), for solubility. Intravenous cyclosporine also requires CrEL and has been associated with pancreatitis. In the cerulein‐induced pancreatitis rat model, paclitaxel with dimethyl sulfoxide as a vehicle prevents pancreatitis, suggesting that another causal agent is responsible. Animal studies of CrEL as a single agent may be required to settle this question, but for now, awareness that paclitaxel may be associated with pancreatitis may lead to earlier treatment of this potentially fatal complication.
Medication Errors in United States Hospitals
Authors: Bond C. A. , Raehl Cynthia L. , Franke Todd
Published: June 2004

This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes measures (severity of illness‐adjusted mortality rates, drug costs, total cost of care, and length of stay) and medication errors. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 mortality data from the Health Care Financing Administration. Simple statistical tests and a severity of illness‐adjusted multiple regression analysis were employed. The study population consisted of 1116 hospitals that reported information on medication errors and 913 hospitals that reported information on medication errors that adversely affected patient care outcomes. We evaluated factors associated with the 430,586 medication errors and 17,338 medication errors that adversely affected patient care outcomes. Medication errors occurred in 5.07% of the patients admitted each year to these hospitals. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that adversely affected patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year. Each hospital experienced a medication error that adversely affected patient care outcomes every 19.23 days (or every 401 admissions). The following factors were associated with increased medication errors/occupied bed/year: lack of pharmacy teaching affiliation (slope = 0.8875, p=0.0416), centralized pharmacists (slope = 1.0942, p = 0.0001), number of registered nurses/occupied bed (slope = 1.624, p=0.032), number of registered pharmacists/occupied bed (slope = 25.0573, p=0.0001), hospital mortality rate (slope = 2.8017, p=0.0192), and total cost of care/occupied bed/year (slope = 0.01432, p=0.0091). Factors associated with decreased medication errors were location in the Mid‐Atlantic census region (slope = −1.5182, p=0.03), affiliation with a pharmacy teaching program (slope = −1.0252, p=0.0349), decentralized pharmacists (slope = −0.9843, p=0.0037), and number of medical residents/occupied bed (slope = −1.478, p=0.0014). There was a 45% decrease in medication errors (1.81‐fold decrease) in hospitals that had decentralized pharmacists, compared with hospitals that had centralized pharmacists. In addition, there was a 94% decrease in medication errors that adversely affected patient care outcomes (16.88‐fold decrease) in hospitals that had decentralized pharmacists compared with hospitals that had only centralized pharmacists. Based on previous field studies and our findings in 1116 hospitals, it appears that one of the most effective ways to prevent or reduce medication errors is to decentralize pharmacists to patient care areas. The results of this study should help hospitals reduce the number of medication errors that occur each year.
Differential Transcription Factor Expression in Human Mononuclear Cells in Response to Amphotericin B: Identification with Complementary DNA Microarray Technology
Authors: Cleary John D. , Rogers P. David , Chapman Stanley W.
Published: June 2004

Study Objective. To identify genes differentially expressed in human monocytic cells exposed to amphotericin B in vitro.

Design. In vitro experiment.

Setting. Hospital laboratory.

Material. Human mononuclear cell line, THP‐1.

Intervention. Human mononuclear cells were exposed to amphotericin B or media alone for 6 hours. After exposure, total RNA was isolated and reverse transcribed to complementary DNA. Differences in probe hybridization observed during blotting were measured, and genes with altered regulation were described by using human complementary DNA microarray technology.

Measurements and Main Results. Of 588 genes represented on the array, 16 transcripts were found to be upregulated and 4 transcripts were downregulated in response to amphotericin B. These findings suggest that amphotericin B alters the expression of genes in human monocytic cells that play a role in many cellular functions, including immune response, signal transduction, and cell differentiation.

Conclusion. Amphotericin B induces alterations in human cell gene transcription. These changes could be used to evaluate differences in toxicity or efficacy observed in patients receiving this agent.
Substance P: A New Era, a New Role
Authors: DeVane C. Lindsay
Published: June 2004

Substance P has been extensively studied and is considered the prototypic neuropeptide of the more than 50 known neuroactive molecules. The understanding of substance P has evolved beyond the original concept as the pain transmitter of the dorsal horn. Animal and genetic research, recent developments of nonpeptide substance P antagonists, and important changes in the understanding of neurotransmission have each contributed to the current understanding of substance P. After 7 decades, the physiologic role of substance P is known as a modulator of nociception, involved in signaling the intensity of noxious or aversive stimuli. Genetic studies in mice and development of substance P antagonists provide more recent results that support the redefinition of the central role of substance P. Evidence suggests that this neuropeptide is an integral part of central nervous system pathways involved in psychologic stress.
Adjunctive Agents in the Management of Chronic Pain
Authors: Guay David R. P.
Published: June 2004

Chronic pain syndromes include cancer‐related pain, postherpetic neuralgia, painful diabetic neuropathy, and central poststroke pain and are common in the elderly. Adjunctive (or adjuvant) analgesics, defined as drugs that do not contain acetaminophen and those not classified as nonsteroidal antiinflammatory or opioid agents, play a role in the management of chronic pain. The term “adjunctive” (or “adjuvant”) is a misnomer as several of these agents may constitute first‐line therapy for many chronic pain syndromes. Tricyclic antidepressants have formed the backbone of therapy for chronic neuropathic pain for years. However, the difficulty with using agents of this class, due to their clinically significant adverse‐event potential, has led to the evaluation of other agents, most notably, the antiepileptic drugs. The most useful are gabapentin, carbamazepine, and lamotrigine. In selected patients, baclofen, mexiletine, and clonidine may be useful as well. Cancer‐related pain may respond substantially to corticosteroids, and pain associated with bone metastases to parenteral bisphosphonates and strontium. Practitioners should consider these alternative agents when treating chronic pain.
A Prospective and Retrospective Analysis of the Nephrotoxicity and Efficacy of Lipid‐Based Amphotericin B Formulations
Authors: Cannon Joan P. , Garey Kevin W. , Danziger Larry H.
Published: June 2004

Study Objective. To determine the usage patterns of the lipid‐based amphotericin B formulations at our institution and to compare the observed nephrotoxicity and efficacy of these formulations.

Design. Prospective and retrospective observational study.

Setting. Urban 350‐bed teaching hospital.

Patients. Sixty‐seven nonhemodialysis patients who were prescribed greater than 3 days of amphotericin B lipid complex (ABLC) or liposomal amphotericin B (L‐AmB) from 1996–1999.

Measurements and Results. Forty‐six patients received ABLC and 21 received L‐AmB. Oncology patients accounted for most prescriptions of both formulations. Amphotericin B lipid complex most frequently was prescribed for treatment of documented fungal infections (50%), followed by treatment of neutropenic fever (33%). Liposomal amphotericin B most frequently was prescribed for treatment of neutropenic fever (62%), followed by treatment of documented fungal infections (29%). Seventy‐eight percent of patients treated with ABLC and 90% of those who received L‐AmB were started on the lipid‐based formulation due to being refractory or intolerant to prior antifungal therapy. Two (4.4%) patients receiving ABLC and four (19%) patients receiving L‐AmB experienced nephrotoxicity at the end of therapy (NS). Of the patients with a documented fungal infection, 20 out of 23 (87%) of those treated with ABLC and 4 out of 5 (80%) of those treated with L‐AmB had a complete or partial response to therapy (NS). One patient with febrile neutropenia had a breakthrough fungal infection while receiving L‐AmB.

Conclusion. No significant differences in nephrotoxicity or efficacy were found between ABLC and L‐AmB. Until further studies indicate clinically significant differences in nephrotoxicity between the two liposomal amphotericin B formulations, it is recommended that economics continue to be the major determinant for product selection.
Lipid‐Lowering Efficacy, Safety, and Costs of a Large‐Scale Therapeutic Statin Formulary Conversion Program
Authors: Taylor Allen J. , Grace Karen , Swiecki Jennifer , Hyatt Richard , Gibbs Henry , Sheikh Munazza , O'Malley Patrick G. , Lowenthal Susan Pitman , West Mark , Spain John , Maneval Kent , Jones David L.
Published: June 2004

Study Objective. To assess the lipid‐lowering efficacy, safety, and costs of a large‐scale statin formulary conversion program.

Design. Prospective, observational study.

Setting. Tertiary academic medical center.

Patients. A total of 980 patients consented to participate; 942 patients completed the study.

Intervention. Patients were converted from their current statin therapy to either cerivastatin 0.4 or 0.8 mg/day, or simvastatin 80 mg/day, using a conversion algorithm.

Measurements and Main Results. Efficacy and safety were evaluated at baseline and after 6 weeks of therapy; costs were also measured. Overall attainment of the National Cholesterol Education Program (NCEP) goal for low‐density lipoprotein cholesterol (LDL) increased from 64.8% to 74.5% of patients (p<0.001); mean LDL decreased from 115 ± 30 mg/dl to 106 ± 25 mg/dl (p<0.001). Adverse events occurred in 3% of patients, and included myositis (0.6%) and increased hepatic transaminases (0.1%). Overall costs were reduced by $115/patient treatment‐year.

Conclusion. Statin therapeutic interchange can improve lipid control at reduced costs. The possibility of uncommon but potentially serious adverse effects suggests that these programs require appropriate monitoring.