bluuebunny/crossref_metadata_2025 huggingface dataset:
Conversion from Intravenous to Sustained-Release Oral Theophylline in Pediatric Patients with Asthma
Authors: Clarke Diana F. , Werbowsky Oksana L. , Grodin Michael A. , Shargel Leon
Published: May 2016

A method for converting pediatric patients from intravenous aminophylline to sustained-release oral theophylline was evaluated in eight asthmatic children. The administration of Theo-Dur tablets two hours before discontinuation of a continuous intravenous aminophylline infusion resulted in a peak rise of 5.6 ± 3.0 /tg/ml over steady-state serum theophylline concentrations. This method of conversion is acceptable in children with equivalent oral and intravenous doses of theophylline and serum theophylline concentrations <15 /ig/ml. Children with steady-state theophylline concentrations >15 /ig/ml are likely to develop concentrations exceeding the therapeutic range using this conversion method.
Individualization of Theophylline Dosage in Adults with Bronchial Asthma
Authors: Otero Maria J. , Barrueco Miguel , Marino Eduardo L. , Gomez Francisco , Dominguez-Gil Alfonso
Published: May 2016

The influence of age on the disposition of theophylline was studied in 95 adult patients (nonsmokers) with bronchial asthma requiring oral theophylline therapy: 17 patients age ≥39 years, 50 patients age 40–59 years, and 28 patients < 60 years. A decrease was observed in total body clearance together with an increase in the elimination half-life of theophylline parallel to the advance in age of the patients. The apparent volume of distribution of theophylline was similar in the three groups of patients. According to the results obtained, recommendations are made regarding the dosage regimens of theophylline in elderly patients.
Topical Mupirocin in the Treatment of Bacterial Skin Infections
Authors: Rumsfield Jean , West Dennis P. , Aronson Iris K.
Published: May 2016

Mupirocin is an investigational topical antibiotic used for treatment and prophylaxis of bacterial skin infections. Mupirocin differs from other antibiotics in its synthesis, structure, and mechanism of action. In vitro, mupirocin possesses antimicrobial activity against staphylococci, streptococci, Hemophilus influenzae, and Neisseria gonorrhoeae. Few studies comparing mupirocin to other topical antibiotics are available. Initial studies comparing mupirocin to inactive vehicle in the treatment of impetigo indicate an overall 92 percent pathogen eradication rate with active drug and 58 percent eradication rate with vehicle. Overall response to treatment of secondary skin infections was favorable in 91 percent of patients treated with mupirocin and 77 percent of those treated with vehicle. Although incidence is not greater than placebo, adverse effects have included pruritus, burning, dry skin, and erythema. Additional trials and clinical use should further help determine the role of mupirocin in the treatment of minor, primary, and secondary skin infections.
Compatibility of Clindamycin Phosphate with Amikacin Sulfate at Room Temperature and with Gentamicin Sulfate and Tobramycin Sulfate under Frozen Conditions
Authors: Marble Dwight A. , Bosso John A. , Townsend Raymond J.
Published: May 2016

The stability and compatibility of clindamycin phosphate with three aminoglycosides, amikacin sulfate, tobramycin sulfate, and gentamicin sulfate, admixed in either glass bottles or plastic bags, were studied under various storage conditions. In addition to the various two-drug combinations, each antibiotic was studied alone in the same solutions under the same storage conditions investigated for the various combinations. Clindamycin phosphate was admixed with amikacin sulfate in 100 ml glass bottles of both dextrose 5% in water (D5W) and NaCl 0.9%. The resultant solutions were examined for visual clarity; both pH and antibiotic concentrations were measured at the time of mixing and at 1, 4, 8, 12, 24, and 48 hours later. The solutions were maintained at room temperature under ambient lighting conditions throughout the observation period. Clindamycin phosphate was also admixed with tobramycin sulfate and gentamicin sulfate, in separate experiments, in 50 ml plastic bags of D5W and NaCl 0.9%. These solutions were examined, at the time of mixing, for visual clarity, pH, and antibiotic concentration and then frozen at −20°C. They were thawed 14 and 28 days later and reexamined. Clindamycin phosphate concentrations were measured by high performance liquid chromatography; those of the aminoglycosides were determined by a fluorescence polarization immunoassay. A working definition of significant instability or incompatibility was defined as a greater than 10 percent loss of original antibiotic concentration. All single antibiotic solutions were stable throughout the observation periods. The clindamycin phosphate-amikacin sulfate combination was stable for 48 hours. While most frozen solutions were stable for 28 days, the tobramycin sulfate-clindamycin phosphate solution was only stable for 14 days, with the tobramycin sulfate concentration decreasing by 16.6 percent from its original concentration at 28 days.
Wound Healing Properties of Cimetidine in Vitro
Authors: Mohamed Seema , Nadijcka Mary D. , Hanson Victor A.
Published: May 2016

Cimetidine was one of a variety of drugs frequently given to surgical patients perioperatively tested for their effect on gap closure of wounded monolayers of human fascia cells in vitro. Cimetidine-treated cultures closed faster and had greater cell proliferation than controls. Closure of cimetidine-treated cultures occurred at six hours compared to ten hours in controls. Cimetidine concentrations of 1000 μg/ml resulted in 13.5 ± 0.67 (SEM) × 104 cells/cm2 at six hours compared to 7.9 ± 0.48 times 104 cells/cm2 in controls (p<0.05); the area covered by cells was 6.5 ± 0.02 mm2 in treated cultures compared to 3.0 ± 0.01 mm2 in controls (p<0.05). It is concluded that cimetidine stimulates fibroblast proliferation in vitro.
Prevention of Recurrent Myocardial Infarction and Sudden Death with Aspirin Therapy
Authors: Rumore Martha M. , Goldstein George S.
Published: May 2016

In October 1985, the Food and Drug Administration approved a new indication of aspirin for the secondary prevention of recurrent myocardial infarction (MI) and death in patients with MI or unstable angina. Clinical trials have demonstrated the efficacy of this drug, especially when treatment is begun soon after the initial event. The antiplatelet actions of aspirin seem to be the most plausible explanation for its efficacy in reducing mortality and the rate of reinfarction. A single daily 325-mg tablet is effective and produces side-effect incidences of only zero to two percent above those produced by placebo. This article assesses the current state of knowledge regarding the value of aspirin therapy in survivors of acute MI and the implications for clinical practice.
Spironolactone-Induced Agranulocytosis
Authors: Jivraj Kabirudeen T. , Noseworthy Thomas W. , Friesen Erwin G. , Shustack Allan S. , Konopad Elsie M. , Johnston Richard G.
Published: May 2016

Agranulocytosis associated with spironolactone administration is described in a 57-year-old man. Four days after initiation of spironolactone, leukocyte counts decreased from 8.2 to 2.3 × 109/L with 6% neutrophils. Spironolactone, domperidone, and prochlorperazine were discontinued. Domperidone and prochlorperazine were reintroduced and there was concomitant improvement of the leukocyte and neutrophil counts. Substitution of triamterene for spironolactone was not associated with recurrent leukopenia. The potential association of spironolactone with granulocytopenia warrants increased awareness of this rare but serious adverse drug reaction.
Ethical Issues in a Drug Information Center
Authors: Arnold Robert M. , Nissen Julia C. , Campbell Norman A.
Published: May 2016

The frequency and nature of ethical issues faced by pharmacists have not been well documented. To address these issues a retrospective study of the potential ethical problems encountered by pharmacists in a drug information center was conducted. Of the 744 calls received over a 13-month period, 50 raised ethical issues. Consumer calls were more likely to raise ethical issues than were health-provider calls. The calls mainly fell into five categories: drug identification, assessment of a physician's recommendations for consumers, conflict between callers' needs and legal or public-health considerations, therapeutic issues in the pharmacist-patient relationship, and paternalistic treatment of “difficult” callers. These questions raised ethical issues related to confidentiality, truth telling, and pharmacists' societal obligations. Pharmacists may confront an increased number of ethical issues as more drug information centers provide consumer services. Although there is no empirical evidence regarding pharmacists' ability to deal with ethical issues, there are reasons to believe that training in medical ethics will better equip pharmacists to recognize, analyze, and resolve ethical dilemmas.
Parkinsonism—Drug Treatment: Part I
Authors: Berg Mary J. , Ebert Barbara , Willis Debra K. , Host Toni , Fincham Richard W. , Schottelius Dorothy D.
Published: May 2016

The purpose of this two-part review is to explain current drug treatment in part I and discuss investigational drug therapy and miscellaneous drugs in the management of parkinsonism in part II. The medical approach to this disease is still based on the imbalance between a deficiency of dopamine and a functional increase in acetylcholine. Anticholinergic agents are used to treat the tremors in the early stages of the disease.
Cibenzoline-Induced Hypoglycemia
Authors: Hilleman Daniel E. , Mohiuddin Syed M. , Ahmed Ismail S. , Dahl Joann M.
Published: May 2016

Antiarrhythmic-induced hypoglycemia is an ill-defined phenomenon. Sporadic cases have been reported with disopyramide, a class IA antiarrhythmic agent. We report a case of cibenzoline-induced hypoglycemia in an elderly male with a history of ischemic heart disease, congestive heart failure, ventricular arrhythmias, and chronic obstructive pulmonary disease. Cibenzoline is a class I antiarrhythmic agent currently undergoing clinical investigation in the U.S. The initial hypoglycemic episode occurred after two years of successful treatment with cibenzoline. Blood glucose during the first hypoglycemic episode was 40 mg/dL. The hypoglycemia was associated with central nervous system depression, hyperkalemia, electrocardiographic abnormalities, and respiratory distress. Rechallenge with cibenzoline resulted in recurrence of symptoms and a blood glucose level of 21 mg/dL. A second rechallenge resulted in symptoms suggestive of hypoglycemia, but cibenzoline was discontinued before frank hypoglycemia and hyperkalemia recurred. Hypoglycemia occurred during periods of fasting, which most likely ruled out reactive-type hypoglycemia. Insulinoma was ruled out by the presence of normal fasting blood glucose and plasma insulin levels. It was concluded that this patient's hypoglycemia was secondary to cibenzoline. Hypoglycemia is a rare and sporadic adverse effect associated with antiarrhythmic therapy. However, the severity of these reactions warrants increased awareness of their occurrence in patients presenting with symptoms of hypoglycemia who are receiving disopyramide or cibenzoline.
Fixed Drug Eruption of the Penis Due to Co-Trimoxazole
Authors: Amir Jacob , Shuper Avinoam , Varsano Izhak , Livni Ella , Mimouni Marc
Published: May 2016

Fixed eruption of the penis, due to co-trimoxazole, is described in two boys.

The eruption was accompanied by severe swelling of the penis, urine retention, and pain during micturition. The migration inhibiting factor assay for co-trimoxazole was negative, but the mast cell degranulation test was strongly positive, suggesting reaginic hypersensitivity reaction.
Direct Method of Simulating Concentration-Time Data for Michaelis-Menten Elimination
Authors: Wagner John G.
Published: May 2016

For pharmacokinetic models such as those indicated by the title, one obtains an implicit equation in concentration, which cannot be used to directly obtain a value of C corresponding to a given value of t. Usually numerical integration is employed to simulate concentration-time data. By introducing f = concentration (C)/initial concentration (C0), or f = C/steady-state concentration (Css), one can replace C by either fC0 or fCss then obtain time as an explicit solution, by letting f equal an arbitrary series of values such as 0.95, 0.9, … 0.05, 0.04 … 0.01 when C0 is involved, or 0.05, 0.10, …, 0.95 when Css is involved. This procedure allows data to be simulated with just a pencil and paper, a hand-held calculator, or a microcomputer. The accuracy of the method depends only on the number of decimal places carried during the calculations. The method can provide a series of C, t values where ΔC is constant, whereas with numerical integration one obtains a series of C, t values where Δt is constant.
Investigational Drug Information; Carbocysteine
Authors: Brown David T.
Published: May 2016

Carbocysteine is prescribed for conditions characterized by the accumulation of excessive mucus. Although often described as a mucolytic, its function is probably that of mucoregulation, which results in physical changes in accumulated secretions that are favorable in terms of clearance. The chemistry, pharmacology, pharmacokinetics, clinical applications, and toxicology of carbocysteine are reviewed.
Octreotide: A Synthetic Analog of Somatostatin
Authors: Rosenberg Jack M.
Published: May 2016

Octreotide is an investigational synthetic peptide exhibiting actions similar to those of endogenous somatostatin. It has a longer half-life than the native hormone and can be administered by subcutaneous injection. Octreotide inhibits the secretion of growth hormone and numerous regulatory peptides of the gastroenteropancreatic system. Trials evaluating the clinical utility of octreotide indicate efficacy in the management of symptoms associated with acromegaly and hypersecretory neuroendocrine tumors, and in the control of nontumoral secretory diarrheas. Octreotide therapy is well tolerated. This agent should prove useful in the symptomatic control of a number of rare hypersecretory disorders.
Single-Dose Efficacy and Safety of Zindotrine, a New Oral Bronchodilator
Authors: Kradjan Wayne A. , Hudson Leonard D. , Harris Diane M. , Emmick Gayle A. , Pierson David J.
Published: May 2016

Zindotrine, a new bronchodilator, may be an alternative to theophylline in treating reversible airflow obstruction. Efficacy and cardiovascular effects of a single 300 mg oral dose of zindotrine were compared with placebo in a two-period, double-blind, crossover trial. Twelve subjects with airflow obstruction reversible after isoproterenol and theophylline completed the trial. Improvement in pulmonary function (forced vital capacity [FVC], forced expiratory volume in one second, and forced expiratory flow rate from 25 to 75 percent of FVC) was greater after zindotrine than with placebo. Pulmonary function tests increased 15 percent or more over baseline in 30 minutes after active drug, lasting up to 6 hours. Mild decreases in heart rate and mean blood pressure occurred after both treatments, with changes equal in both treatment groups. Six subjects had mild subjective side effects after zindotrine (headache, dizziness, vertigo, flushing, and heartburn) compared with one report of lightheadedness after placebo. A single dose of zindotrine 300 mg provides effective bronchodilator action with a relatively prolonged response and tolerable side effects.
The Pharmaceutical Sciences as Academic Disciplines
Authors: Lemberger August P.
Published: May 2016

Recent studies of higher education in America have raised concern over the lack of integrity and coherence, the absence of vigorous intellectual exchange, and the dominance of careerism in the undergraduate curriculum. Observations and recommendations emanating from studies of pharmaceutical education acknowledge the importance of problem-solving abilities but emphasize the inculcation of knowledge relevant to professional functions and the development of skill in contemporary practice. The current emphasis placed on training students for pharmacy practice found in the pharmacy curriculum causes the objective of achieving intellectual growth to be overshadowed. Balance must be restored. The pharmaceutical sciences, taught for their value as academic disciplines and for their integrity with other branches of science, could serve as the stimulus for intellectual growth of students. An academic baccalaureate program with a major in pharmaceutical sciences as the required base for professional education is proposed as a remedy.
Vasopressor Effect of Epinephrine with and without Dopamine during Cardiopulmonary Resuscitation
Authors: Gonzalez Edgar R. , Ornato Joseph P. , Levine Ronald L.
Published: May 2016

We prospectively studied nine prehospital cardiac arrest patients (six M, three F; aged 60 ± 8 yr) to determine the vasopressor response following incremental (1, 3, and 5 mg) doses of intravenous epinephrine given 5 minutes apart with or without dopamine 15 μg/kg/min. All patients were in ventricular fibrillation on arrival of the paramedics and were not resuscitated with standard advanced cardiac life support therapy. Cardiopulmonary resuscitation (CPR) was performed with a computerized Thumper at 60 compressions/min with a 50:50 downstroke-to-upstroke ratio. All patients were intubated and received 12 ventilations/min at a fraction of inspired oxygen of 80 percent. Radial artery pressure was monitored through a #20 gauge radial artery catheter inserted by cutdown within ten minutes after arrival at the emergency room. Five patients received epinephrine alone (group A) and four received epinephrine plus dopamine (group B). The patient's age, paramedic response time, arterial blood gases, and initial diastolic blood pressure (BP) did not differ significantly between treatment groups. Baseline systolic BP was significantly higher (p < 0.01) in group B (68 ± 10 mm Hg) than in group A (35 ± 5 mm Hg). Epinephrine produced a dose-dependent vasopressor response in group A, but not in group B. In group A, peak systolic BP following epinephrine 1, 3, and 5 mg was 57 ± 20, 69 ± 23, and 76 ± 27 mm Hg, respectively (p < 0.05 for 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (81 ± 13, 80 ± 18, and 78 ± 19 mm Hg). In group A, peak diastolic BP following epinephrine 1, 3, and 5 mg was 24 ± 8, 28 ± 16, and 31 ± 6 mm Hg, respectively (p < 0.05 for epinephrine 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (33 ± 10, 33 ± 11, and 34 ± 13 mm Hg). Epinephrine produces a dose-dependent vasopressor response during CPR in humans. The administration of high doses of epinephrine to patients receiving high-dose dopamine does not produce an additive vasopressor response.
Compatibility and Stability of Cefazolin Sodium, Clindamycin Phosphate, and Gentamicin Sulfate in Two Intravenous Solutions
Authors: Zbrozek Arthur S. , Marble Dwight A. , Bosso John A.
Published: May 2016

We studied the compatibility and stability of clindamycin phosphate admixed with gentamicin sulfate and cefazolin sodium in small-volume diluents under specific storage conditions. In two replicate 100 ml dilutions of NaCl 0.9% injection and dextrose 5% (D5W) injection, clindamycin phosphate 900 mg was admixed with gentamicin sulfate 80 mg and cefazolin sodium 1 g. Drug concentrations were determined at the time of preparation and at 1, 4, 8, 12, 24, and 48 hours. Clindamycin and cefazolin were assayed by high-performance liquid chromatography and gentamicin was assayed by fluorescence polarization immunoassay. Visual inspections and pH determinations of each solution were performed at each assay time. Test solutions were maintained at constant room temperature and fluorescent lighting. Concentrations of clindamycin and gentamicin remained >90 percent of the original concentrations throughout the study. Cefazolin concentrations dropped below 90 percent in D5W injection at 4 hours after admixture and at 12 hours after admixture in NaCl 0.9% injection. Visual analyses and pH changes revealed no significant changes. The combination of clindamycin phosphate 900 mg, gentamicin sulfate 80 mg, and cefazolin sodium 1 g in D5W 100 ml was found to be compatible for up to 4 hours. The duration of compatibility for these three drugs in 100 ml of NaCl 0.9% was 12 hours.
Clinical Pharmacy Administration
Authors: Einarson Thomas R.
Published: May 2016

Clinical pharmacy administration has emerged as a separate discipline, but this new field has not been functionally defined. This article defines clinical pharmacy administration from an academic point of view and provides a framework within which it may be understood. It is an applied field of study that deals with the research, evaluation, and management of the patient, the drug, and the health care practitioner as they all relate to patient care. These entities and relationships are studied at the micro, macro, and global levels from financial, economic, managerial, legal, ethical, social, behavioral, educational, and historical perspectives. It is intended that this paper generate debate and discussion in order to refine and develop the field.
Cost Justification of Clinical Pharmacy Services on a General Surgery Team: Focus on Diagnosis-Related Group Cases
Authors: Bertch Karen E. , Hatoum Hind T. , Willett Michael S. , Witte Kenneth W.
Published: May 2016

We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated.

The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient. Total cost avoidance was $465.12 per patient and the cost of clinical pharmacy services was $23.66 per patient; net cost avoidance was therefore $441.46 per patient. For the duration of the study, the clinical pharmacist documented that similar input was required and actually provided to 40 percent of the patients admitted to the service. Based on an annual census of 1000 patients, the projected annual net cost avoidance was $176 584.
Intravenous Self-Administration of Elemental Mercury: Efficacy of Dimercaprol Therapy
Authors: Murray Kim M. , Hedgepeth Jennifer C.
Published: May 2016

Deliberate parenteral self-injection of mercury is extremely rare, and is associated with a high degree of mortality and morbidity. Because mercury depresses cellular enzymatic mechanisms by combining with sulfhydryl groups, soluble mercuric salts are toxic to all cells. Embolization of mercury in the lungs has been reported with varying degrees of changes in pulmonary function. Mercury causes urticaria progressing to weeping dermatitis, leukopenia, anemia, diarrhea, salivation, liver damage, and renal damage progressing to acute renal failure with anuria. Dimercaprol is an effective antidote in acute heavy metal intoxication because its two sulfhydryl groups successfully compete with tissue enzyme sulfhydryl groups for the offending metal. Experience with dimercaprol therapy months after the original exposure to mercury is not available. We describe the hospital course of a patient after intravenous elemental injection and the results of dimercaprol therapy months after the original exposure.
Profile of Prescription Medication in a Pediatric Population
Authors: Olubadewo Joseph O. , Ikponmwamba Ann
Published: May 2016

This retrospective study describes the prescription medication profile in an outpatient pediatric population (n = 510) retrieved from a hospital pharmacy computer file. The survey covers a three-month period. The study population included 281 male and 229 female patients divided according to age into three groups: infant (age 0–12 months); children (age 1–12 years); and adolescents (age 13–18 years). Medications prescribed were classified according to their pharmacotherapeutic properties as described in the American Hospital Formulary Service Drug Information 87. The findings pointed out that three pharmacotherapeutic categories (the antiinfective/chemotherapeutic, central nervous system (CNS), and respiratory agents) constituted 78.1 percent of the 1402 prescribed medications. The most frequently prescribed agents in each of these categories were, respectively, amoxicillin, aminophylline, and acetaminophen. These agents represent recent advances in drug usage because they became most frequently used only within the past ten years. The age-dependent medication profile indicated that there was a higher prescription rate of antiinfectives and respiratory disorder agents in the younger age groups; in the adolescent group CNS agents were more often prescribed.
Performance evaluation of holonic control of a switch arrival system
Authors: Indriago Carlos , Cardin Olivier , Bellenguez-Morineau Odile , Rakoto Naly , Castagna Pierre , Chacòn Edgar
Published: May 2016

The application of holonic paradigm to the hybrid control system class is a promising way to give flexibility to the control of such systems, leading to new industrial intelligent processes. However, there is a need for performance evaluation of such solutions in order to give them credit among the multiple formalisms used in the literature. This article aims at evaluating the optimality and stability of the holonic control of a switch arrival system, a classical system from the literature where a unique server has to switch between leaking tanks full of fluids before they get empty. Optimality is evaluated compared to a scheduling algorithm aimed at minimizing the number of switches of the server while respecting the constraints. Stability is evaluated through a stochastic simulation run aiming at finding cyclic behavior of the control in a whole set of random initial configurations. The results tend to show a good overall performance of the control, especially considering the algorithms used are quite simple, thus could be made better and enhance the performance.
Do Biologics Protect Patients With Psoriasis From Myocardial Infarction? A Retrospective Cohort
Authors: Gulliver Wayne P. , Randell Shane , Gulliver Susanne , Connors Sean , Bachelez Hervé , MacDonald Don , Gladney Neil , Morrissey Andrea , Fleming Patrick
Published: May 2016

Background:

Psoriasis is a chronic immune-mediated inflammatory disorder that affects approximately 2% to 3% of the population, which translates to 17 million in North America and Europe and approximately 170 million people worldwide. Although psoriasis can occur at any age, most cases develop before age 40 years. Some larger studies have noted bimodal age at onset with the first peak occurring at approximately age 30 years and the second peak at around 55 to 60 years, but most patients have a younger age of onset (15-30 years). Psoriasis is associated with multiple comorbidities, decreased quality of life, and decreased longevity of life. Two recent systematic reviews and a meta-analysis concluded that psoriasis patients are at increased risk of major adverse cardiovascular events. Multiple studies confirm that many of the comorbidities found in patients with psoriasis are also important risk factors for cardiovascular disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, obesity, and metabolic syndrome.

Methods:

We conducted a retrospective cohort study using charts from a dermatology clinic combined with an administrative database of patients with moderate to severe psoriasis in Newfoundland and Labrador, Canada. We examined the role of clinical predictors (age of onset of psoriasis, age, sex, biologic use) in predicting incident myocardial infarction (MI).

Results:

Logistic regression revealed that age of onset (odds ratio [OR], 8.85; P = .005), advancing age (OR, 1.07; P < .0001), and being male (OR, 3.64; P = .018) were significant risk factors for the development of MI. Neither biologic therapy nor duration of biologic therapy were statistically significant risk factors for the development of MI. Our study found that in patients with psoriasis treated with biologics, there was a nonsignificant trend in reduced MI by 78% (relative risk, 0.18; 95% confidence interval, 0.24-1.34; P = .056).

Conclusion:

Our study demonstrated a trend toward decreased MI in patients with moderate to severe psoriasis on biologics. Patients with an early age of onset of psoriasis (<25 years) were nearly 9 times more likely to have an MI. Clinicians should consider appropriate cardiovascular risk reduction strategies in patients with psoriasis.
What does it take to make it to the polling station? The effects of campaign activities on electoral participation
Authors: Trumm Siim , Sudulich Laura
Published: May 2016

This study explores the extent to which campaign visibility facilitates electoral participation, using data from first- and second-order elections in Britain. Our contribution to the existing literature is threefold. First, we assess whether the effects of campaign effort are conditioned by marginality, finding that campaign mobilization gets out the vote regardless of the competitiveness of the race. Second, we look at the relative ability of different campaign activities to stimulate turnout, detecting significant differences. Third, we show that the effects of campaign effort on electoral participation are rather similar in first- and second-order elections. These findings suggest that a greater level of electoral information provided by campaign activities does reduce the cost of voting. Local campaigns play a key role in bringing voters to the polls in marginal and non-marginal races and at general elections as much as at second-order elections.
Strain modes identification using cross-correlation function of measured dynamic strain
Authors: Wang Zuo-Cai , Huang Chun-Yang , He Zhi-Chao , Wang Yong-Ping
Published: May 2016

Strain modes of structures reflect the distribution rule of dynamic strain and can be of service to structural health monitoring. This article presents a new method to estimate the strain modes of beam structures based on the measured dynamic strain. Since the cross-correlation matrix of the modal coordinates is a diagonal matrix, thus, the cross-correlation matrix of the measured dynamic strain is also a diagonal matrix, and the strain modes can be obtained to find the eigenvectors of the strain cross-correlation matrix. The strain modes of a simply support beam and a continuous beam subjected to various impulsive excitations are identified from the numerical simulations using the proposed method. The noise effect is also investigated in this article. The numerical results show that the proposed method can effectively identify the strain modes even with noise effect. Finally, the method is verified through the experiment of a simply supported beam under hammering excitation. The test results also show that the proposed method can estimate the strain modes of beam structures with a high accuracy.
Bedside identification of blunt thoracic aortic injury with point-of-care transesophageal echocardiography
Authors: Landau John H , Power Adam H , Leeper W Robert , Arntfield Robert T
Published: May 2016

Trauma point-of-care ultrasound in the form of the Focused Assessment with Sonography for Trauma (FAST) exam and its evolution into extended FAST have significantly enhanced the diagnostic power of evaluation and resuscitation of the trauma patient; however, these modalities still have limitations in evaluating mediastinal and cardiac pathology. This report demonstrates a case of point-of-care transesophageal echocardiography in the diagnosis of blunt thoracic aortic injury in an unstable patient involved in a motor vehicle collision.
Dementia and representative democracy: Exploring challenges and implications for democratic citizenship
Authors: Sonnicksen Jared
Published: May 2016

Despite growing recognition of the rights of people with dementia for full citizenship, issues related to democracy, whether from theoretical or practical perspectives, remain neglected. Especially since discourses on dementia have expanded to this rights-based approach, it is imperative to begin to examine the meanings and practices of democracy within a context of dementia. Accordingly, the purpose of this article is to assess implications of dementia in the context of democracy. Rather than surveying the variety of democratic concepts, it will focus the analytical framework on representative democracy and then outline several challenges to and for representative democracy and citizens with dementia. The intention is to begin to identify paths for ensuring representation, inclusion and participation for those who have dementia.
How do lesbian and gay people experience dementia?
Authors: McParland James , Camic Paul M
Published: May 2016

Introduction

The subjective experience of dementia for lesbian and gay individuals is largely absent from the extant literature. This study aimed to explore what it means to experience dementia in this context given the documented psychosocial influences facing this population. A second aim was to develop understanding of these experiences within dyadic relationships.

Method

Ten semi-structured interviews were conducted with lesbian and gay individuals with dementia and people with whom they had a significant relationship and analysed using interpretative phenomenological analysis.

Results

Three superordinate themes, reflecting characteristics of participants’ experience, were identified: duality in managing dementia, giving yourself away vs. holding onto yourself and relationships as sheltered harbours. Ten subthemes indicated the processes that were adopted to adjust and make sense of the experience of dementia. These included decisions around concealment, ensuring safety and the promotion of personhood and couplehood. In line with findings for heterosexual couples, partners had an important role in maintaining the identity of the person with dementia.

Conclusions

Results suggest additional and distinct challenges, including experienced and perceived discrimination and heterosexism. In response to these conditions, interviewees worked to resist a ‘double stigma’ of dementia and sexuality. Findings indicated areas of improvement for dementia services, including training in inclusive practice.
Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform
Authors: Xue Ying , Intrator Orna
Published: May 2016

The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. The current article provides policy recommendations for leveraging and expanding the historic role of NPs in caring for vulnerable populations, by focusing on three key policy levers: NP scope-of-practice regulation, distribution of the NP workforce, and NP education. These policy levers must go hand in hand to build a sufficient and equitably distributed NP workforce, to help meet the escalating need for primary care in an era of health-care reform.
Improving mechanical properties of ramie/poly (lactic acid) composites by synergistic effect of fabric cyclic loading and alkali treatment
Authors: Yang Jianxia , Zhu Luping , Yang Zhuo , Yao Lan , Qiu Yiping
Published: May 2016

Natural cellulose fiber reinforced biopolymer composites have attracted increasing attention due to environmental concerns. However, these fibers have relatively low mechanical properties and poor interfacial adhesion with matrices, limiting their composite mechanical properties. This study investigates the synergistic effect of two recently developed techniques to maximize the mechanical performance of ramie/poly (lactic acid) laminated composites, namely alkali treatment to loosen fiber molecular structure and to increase fiber surface roughness and subsequent cyclic loading treatment to fabrics to increase their tensile strength and modulus. The results show that the treated fabrics have increased crystallinity and crystal orientation factor as well as better orientation of fibers and more uniform structures, leading to 11% improvement in fabric tensile strength and 57% enhancement of tensile strength (90.9 MPa), 48% higher tensile modulus (5.6 GPa), 18% higher flexural strength (149.4 MPa), and 91% higher flexural modulus (8.2 GPa) for the corresponding composites. Meanwhile, postmortem analysis shows that better interfacial adhesion is achieved using this approach.
The use of CD47-modified biomaterials to mitigate the immune response
Authors: Tengood Jillian E , Levy Robert J , Stachelek Stanley J
Published: May 2016

Addressing the aberrant interactions between immune cells and biomaterials represents an unmet need in biomaterial research. Although progress has been made in the development of bioinert coatings, identifying and targeting relevant cellular and molecular pathways can provide additional therapeutic strategies to address this major healthcare concern. To that end, we describe the immune inhibitory motif, receptor–ligand pairing of signal regulatory protein alpha and its cognate ligand CD47 as a potential signaling pathway to enhance biocompatibility. The goals of this article are to detail the known roles of CD47–signal regulatory protein alpha signal transduction pathway and to describe how immobilized CD47 can be used to mitigate the immune response to biomaterials. Current applications of CD47-modified biomaterials will also be discussed herein.
The relationship between mineral composition, crystal structure and paragenetic sequence: the case of secondary Te mineralization at the Bird Nest drift, Otto Mountain, California, USA
Authors: Christy Andrew G. , Mills Stuart J. , Kampf Anthony R. , Housley Robert M. , Thorne Brent , Marty Joe
Published: May 2016

An unusually diverse array of 25 secondary Te oxysalt minerals has been documented from Otto Mountain, California, and 18 of these from the Bird Nest drift sublocality. A paragenetic sequence for these minerals is proposed, using observed overgrowth relationships plus spatial association data and data from other localities. Apart from Te and O, the components Pb, Cu and H are essential in the majority of the minerals. The atomic Cu/Te ratio decreases through the paragenetic sequence. This, and the occurrence of minerals with additional components such as Cl–, CO32–, SO42–and Fe3+at an intermediate stage, suggests nonmonotonic evolution of the parent fluids, reflecting differing access to or spatial distribution of various components. For the minerals with known crystal structures, two alternative 'structural units' were identified, one consisting only of the Te4+or Te6+oxyanion, while the other also included small, strongly-bound cations such as Cu2+. The degree of polymerization for the Te oxyanion correlated with the paragenetic sequence: the monomeric tellurate anions of early minerals were replaced progressively by dimers, chains and sheet structures, which may relate to a decreasing abundance of the 'network modifying' Cu2+cation, analogous to Bowen's discontinuous reaction series in igneous rock-forming silicates. No relationship was seen between paragenetic order and the larger type of structural unit, or structural complexity as defined by information content. This contrasts with results in the literature for evaporite sulfates and pegmatite phosphates. While structure–paragenesis relationships may be widespread, the exact nature of such relationships may be different for different chemical systems and different paragenetic environments.
Easier Said Than Done: Keys to Successful Implementation of the Distress Assessment and Response Tool (DART) Program
Authors: Li Madeline , Macedo Alyssa , Crawford Sean , Bagha Sabira , Leung Yvonne W. , Zimmermann Camilla , Fitzgerald Barbara , Wyatt Martha , Stuart-McEwan Terri , Rodin Gary
Published: May 2016

Purpose:

Systematic screening for distress in oncology clinics has gained increasing acceptance as a means to improve cancer care, but its implementation poses enormous challenges. We describe the development and implementation of the Distress Assessment and Response Tool (DART) program in a large urban comprehensive cancer center.

Method:

DART is an electronic screening tool used to detect physical and emotional distress and practical concerns and is linked to triaged interprofessional collaborative care pathways. The implementation of DART depended on clinician education, technological innovation, transparent communication, and an evaluation framework based on principles of change management and quality improvement.

Results:

There have been 364,378 DART surveys completed since 2010, with a sustained screening rate of > 70% for the past 3 years. High staff satisfaction, increased perception of teamwork, greater clinical attention to the psychosocial needs of patients, patient-clinician communication, and patient satisfaction with care were demonstrated without a resultant increase in referrals to specialized psychosocial services. DART is now a standard of care for all patients attending the cancer center and a quality performance indicator for the organization.

Conclusion:

Key factors in the success of DART implementation were the adoption of a programmatic approach, strong institutional commitment, and a primary focus on clinic-based response. We have demonstrated that large-scale routine screening for distress in a cancer center is achievable and has the potential to enhance the cancer care experience for both patients and staff.
Trialkyltin Rexinoid-X Receptor Agonists Selectively Potentiate Thyroid Hormone Induced Programs of Xenopus laevis Metamorphosis
Authors: Mengeling Brenda J. , Murk Albertinka J. , Furlow J. David
Published: May 2016

The trialkyltins tributyltin (TBT) and triphenyltin (TPT) can function as rexinoid-X receptor (RXR) agonists. We recently showed that RXR agonists can alter thyroid hormone (TH) signaling in a mammalian pituitary TH-responsive reporter cell line, GH3.TRE-Luc. The prevalence of TBT and TPT in the environment prompted us to test whether they could also affect TH signaling. Both trialkyltins induced the integrated luciferase reporter alone and potentiated TH activation at low doses. Trimethyltin, which is not an RXR agonist, did not. We turned to a simple, robust, and specific in vivo model system of TH action: metamorphosis of Xenopus laevis, the African clawed frog. Using a precocious metamorphosis assay, we found that 1nM TBT and TPT, but not trimethyltin, greatly potentiated the effect of TH treatment on resorption phenotypes of the tail, which is lost at metamorphosis, and in the head, which undergoes extensive remodeling including gill loss. Consistent with these responses, TH-induced caspase-3 activation in the tail was enhanced by cotreatment with TBT. Induction of a transgenic reporter gene and endogenous collagenase 3 (mmp13) and fibroblast-activating protein-α (fap) genes were not induced by TBT alone, but TH induction was significantly potentiated by TBT. However, induction of other TH receptor target genes such as TRβ and deiodinase 3 by TH were not affected by TBT cotreatment. These data indicate that trialkyltins that can function as RXR agonists can selectively potentiate gene expression and resultant morphological programs directed by TH signaling in vivo.
ANALYSIS OF THE MATHEMATICAL DEPENDENCIES EKV MODELS TO FORMALIZE PROCEDURES OF THE DESIGNING MOS-TRANSISTOR
Authors: Лавлинский  , Lavlinskiy V. , Жвад  , Zhvad Akhmed
Published: May 2016

In article is considered mathematical dependencies EKV models to formalize procedures of the designing MOS-transistor.
SOLUTION APPLICATIONS OPERATION OF GAS SUPPLY SYSTEMS TO ENSURE THEIR SAFETY
Authors: Сазонова  , Sazonova Svetlana
Published: May 2016

For the functioning of the system of gas supply deals with methods of solving the problem of static evaluation. In the diagnosis of the technical state of functioning of gas supply systems in the software of the automated control systems need to solve the problem of static evaluation. In the real world there is a lack of experimental data on the state of functioning of gas supply systems. Using modern scientific approach to the formation of psevdoizmereny in the problem of static evaluation will be possible to overcome the uncertainty of operating information systems. Availability of full information about the current state of the system will ensure its security at the expense of efficiency prinyantiya decisions in the event of accidents or change the mode of operation.
A Constraint-Programming-Based Branch-and-Price-and-Cut Approach for Operating Room Planning and Scheduling
Authors: Hashemi Doulabi Seyed Hossein , Rousseau Louis-Martin , Pesant Gilles
Published: May 2016

This paper presents an efficient algorithm for an integrated operating room planning and scheduling problem. It combines the assignment of surgeries to operating rooms and scheduling over a short-term planning horizon. This integration results in more stable planning through consideration of the operational details at the scheduling level, and this increases the chance of successful implementation. We take into account the maximum daily working hours of surgeons, prevent the overlapping of surgeries performed by the same surgeon, allow time for the obligatory cleaning when switching from infectious to noninfectious cases, and respect the surgery deadlines. We formulate the problem using a mathematical programming model and develop a branch-and-price-and-cut algorithm based on a constraint programming model for the subproblem. We also develop dominance rules and a fast infeasibility-detection algorithm based on a multidimensional knapsack problem to improve the efficiency of the constraint programming model. The computational results show that our method has an average optimality gap of 2.81% and significantly outperforms a compact mathematical formulation in the literature.
Peer-led postgraduate education across medicine and psychiatry
Authors: Demir Ozan M , Abdullah Rezaur , Srivastava Vivek
Published: May 2016

Peer-led education is well established in undergraduate education, but there is a paucity of data regarding its role in postgraduate education. This article assesses the feasibility of peer-led teaching in postgraduate medical education and evaluates its benefits through qualitative structured feedback.