bluuebunny/crossref_metadata_2025 huggingface dataset:
Ways of knowing on the Internet: A qualitative review of cancer websites from a critical nursing perspective
Authors: Haase Kristen R , Thomas Roanne T. , Gifford Wendy , Holtslander Lorraine F.
Published: January 2018

People diagnosed with cancer typically want information from their doctor or nurse. However, many individuals now turn to the Internet to tackle unmet information needs and to complement healthcare professional information. The purpose of this study was to qualitatively explore the content of commonly searched cancer websites from a critical nursing perspective, as this information is accessible, and allows patients to address their information needs in ways that healthcare professionals cannot. This qualitative examination of websites is informed by Carper's fundamental patterns of knowing and complemented with the critical view to technology espoused by the philosophy of technology. We conducted a review of 20 websites using a two‐step interpretive descriptive approach and thematic analysis. We identified the dominant discourse to be focused on empirical information on treatment, prognosis, and cure, and a paucity of sociopolitical, ethical, personal, and esthetic information. In place of holistic, nuanced, and accurate knowledge nurses may provide, patients find predominantly empirical and biomedical information online. Discussion explores and critiques online cancer content, gaps in information, and the importance of information diversity. Implications focus on needed discourse around pervasive technologies and the nursing role in assessing and directing patients to holistic information.
A maize phytochrome‐interacting factors protein ZmPIF1 enhances drought tolerance by inducing stomatal closure and improves grain yield in Oryza sativa
Authors: Gao Yong , Wu Meiqin , Zhang Mengjiao , Jiang Wei , Ren Xiaoyun , Liang Enxing , Zhang Dongping , Zhang Changquan , Xiao Ning , Li Yan , Dai Yi , Chen Jianmin
Published: January 2018

Phytochrome‐interacting factors (PIFs) play major roles in regulating plant growth and development, but their roles in drought stress remain elusive. Here, we cloned and characterized a maize (Zea mays) PIF transcription factor, ZmPIF1. The expression level of ZmPIF1 was significantly induced by independent drought and abscisic acid (ABA) treatments. The ZmPIF1 transgenic rice and Arabidopsis displayed water saving and drought resistance, which were associated with reduced a stomatal aperture and transpiration rate. Moreover, the ZmPIF1 transgenic rice were hypersensitive to exogenous ABA, while the endogenous ABA level was not significantly changed, suggesting that ZmPIF1 was a positive regulator of the ABA signalling pathway. Digital gene expression (DGE) results further indicated that ZmPIF1 participated in ABA signalling pathway and regulated the stomatal aperture in rice. In addition, grain yield and agronomic traits analysis over 4 years showed that ZmPIF1 was able to increase the grain yield through an increase in tiller and panicle numbers in transgenic rice. Overall, ZmPIF1 plays an important role in the ABA‐mediated regulation of stomatal closure to control water loss. ZmPIF1 can enhance water saving and drought resistance and improve the crop yield in rice, illustrating the capacity of ZmPIF1 for crop improvement.
Convergence Analysis of MCMC Algorithms for Bayesian Multivariate Linear Regression with Non‐Gaussian Errors
Authors: Hobert James P. , Jung Yeun Ji , Khare Kshitij , Qin Qian
Published: January 2018

When Gaussian errors are inappropriate in a multivariate linear regression setting, it is often assumed that the errors are iid from a distribution that is a scale mixture of multivariate normals. Combining this robust regression model with a default prior on the unknown parameters results in a highly intractable posterior density. Fortunately, there is a simple data augmentation (DA) algorithm and a corresponding Haar PX‐DA algorithm that can be used to explore this posterior. This paper provides conditions (on the mixing density) for geometric ergodicity of the Markov chains underlying these Markov chain Monte Carlo algorithms. Lettingddenote the dimension of the response, the main result shows that the DA and Haar PX‐DA Markov chains are geometrically ergodic whenever the mixing density is generalized inverse Gaussian, log‐normal, inverted Gamma (with shape parameter larger thand/2) or Fréchet (with shape parameter larger thand/2). The results also apply to certain subsets of the Gamma,Fand Weibull families.
Use of digital image correlation to measure strain recovery in particle toughened thermoset resins
Authors: Salmon Guzman F. , Jackson M. , Jones S. , Tomlinson R. A.
Published: January 2018

A methodology for finding the yield point of epoxy resins, both neat and particulate toughened, is described. Trends of the effect that particulate filling has on the time dependent response of these materials were constructed from observations made with stereo‐based digital image correlation (3D–DIC), namely, creep and stress relaxation at constant load. The use of 3D–DIC also enabled the observation of differences in deformation mechanisms resulting from the particle addition. The focus is put on the technique's potential to characterise materials and produce clear relationships between composition and mechanical strain response. The methodology proposed herein allows the observation and study of multiple deformation mechanisms from a single test, and thus can potentially minimise the number of specimens needed for a comprehensive test campaign.
Flow Resistance Coefficients of Porous Brush Seal as a Function of Pressure Load
Authors: Doğu Yahya , Sertçakan Mustafa C. , Gezer Koray , Kocagül Mustafa
Published: January 2018

Developments in brush seal analyses tools have been covering advanced flow and structural analyses since brush seals are applied at elevated pressure loads, temperatures, surface speeds, and transients. Brush seals have dynamic flow and structural behaviors that need to be investigated in detail in order to estimate final leakage output and service life. Bristles move, bend, and form a grift matrix depending on pressure load. The level of pressure load determines the tightness of the bristle pack, and thus, the leakage. In the computational fluid dynamics (CFD) analyses of this work, the bristle pack is treated as a porous medium. Based on brush seal test data, the flow resistance coefficients (FRC) for the porous bristle pack are calibrated as a function of pressure load. A circular seal is tested in a static test rig under various pressure loads at room temperature. The FRC calibration is based on test leakage and literature-based axial pressure distribution on the rotor surface and radial pressure distribution over the backing plate. The anisotropic FRC are treated as spatial dependent in axisymmetrical coordinates. The fence height region and the upper region of bristle pack have different FRC since the upper region is supported by backing plate, while bristles are free to move and bend at the fence height region. The FRC are found to be almost linearly dependent on the pressure load for investigated conditions. The blow-down is also calculated by incorporating test leakage and calibrated FRC.
Hybrid Digital Image Correlation–Finite Element Modeling Approach for Modeling of Orthogonal Cutting Process
Authors: Zhang Dong , Zhang Xiao-Ming , Ding Han
Published: January 2018

Cutting process modeling is still a significant challenge due to the severe plastic deformation of the workpiece and intense friction between the workpiece and tool. Nowadays, a novel experimental approach based on digital image correlation (DIC) technique has been utilized to study the severe deformation of the workpiece. However, the experimentally measured velocity field does not necessarily satisfy the equilibrium equation that is one of the fundamental governing equations in solid mechanics due to the measurement errors; hence, accurate stress fields could hardly be derived. In this paper, we propose a hybrid DIC-FEM approach to optimize the velocity field and generate a stress field that is in an equilibrium state. First, the analysis region for finite element modeling (FEM) is selected according to the captured image, and the DIC results are used to track the deformation history of the material points. Secondly, the deviatoric stresses of the analysis region are calculated by employing the plastic theory. Thirdly, the hydrostatic pressures are acquired through solving over-constrained equations derived through FEM. Finally, the velocity field is optimized to satisfy the equilibrium equation and the boundary conditions (BCs) with the DIC results serving as an initial value of the workpiece velocity field. To validate this approach, the deformations including the velocity and strain yielded by the hybrid method are compared with the DIC results. The stress fields are presented to demonstrate the satisfaction of the equilibrium equation and the BCs. Moreover, cutting forces calculated through the integration of the stress tensors are compared against the FEM simulations and the experimental measurement.
Acquisition of a Novel Sulfur-Oxidizing Symbiont in the Gutless Marine Worm Inanidrilus exumae
Authors: Bergin C. , Wentrup C. , Brewig N. , Blazejak A. , Erséus C. , Giere O. , Schmid M. , De Wit P. , Dubilier N.
Published: January 2018

Gutless phallodrilines are marine annelid worms without a mouth or gut, which live in an obligate association with multiple bacterial endosymbionts that supply them with nutrition. In this study, we discovered an unusual symbiont community in the gutless phallodriline
Inanidrilus exumae
that differs markedly from the microbiomes of all 22 of the other host species examined. Comparative 16S rRNA gene sequence analysis and fluorescence
in situ
hybridization revealed that
I. exumae
harbors cooccurring gamma-, alpha-, and deltaproteobacterial symbionts, while all other known host species harbor gamma- and either alpha- or deltaproteobacterial symbionts. Surprisingly, the primary chemoautotrophic sulfur oxidizer “
Candidatus
Thiosymbion” that occurs in all other gutless phallodriline hosts does not appear to be present in
I. exumae
. Instead,
I. exumae
harbors a bacterial endosymbiont that resembles “
Ca
. Thiosymbion” morphologically and metabolically but originates from a novel lineage within the class
Gammaproteobacteria
. This endosymbiont, named Gamma 4 symbiont here, had a 16S rRNA gene sequence that differed by at least 7% from those of other free-living and symbiotic bacteria and by 10% from that of “
Ca
. Thiosymbion.” Sulfur globules in the Gamma 4 symbiont cells, as well as the presence of genes characteristic for autotrophy (
cbbL
) and sulfur oxidation (
aprA
), indicate that this symbiont is a chemoautotrophic sulfur oxidizer. Our results suggest that a novel lineage of free-living bacteria was able to establish a stable and specific association with
I. exumae
and appears to have displaced the “
Ca
. Thiosymbion” symbionts originally associated with these hosts.

IMPORTANCE
All 22 gutless marine phallodriline species examined to date live in a highly specific association with endosymbiotic, chemoautotrophic sulfur oxidizers called “
Ca
. Thiosymbion.” These symbionts evolved from a single common ancestor and represent the ancestral trait for this host group. They are transmitted vertically and assumed to be in transition to becoming obligate endosymbionts. It is therefore surprising that despite this ancient, evolutionary relationship between phallodriline hosts and “
Ca
. Thiosymbion,” these symbionts are apparently no longer present in
Inanidrilus exumae
. They appear to have been displaced by a novel lineage of sulfur-oxidizing bacteria only very distantly related to “
Ca
. Thiosymbion.” Thus, this study highlights the remarkable plasticity of both animals and bacteria in establishing beneficial associations: the phallodriline hosts were able to acquire and maintain symbionts from two very different lineages of bacteria, while sulfur-oxidizing bacteria from two very distantly related lineages were able to independently establish symbiotic relationships with phallodriline hosts.
Simulating the impact of excise taxation for disease prevention in low-income and middle-income countries: an application to South Africa
Authors: Stacey Nicholas , Summan Amit , Tugendhaft Aviva , Laxminarayan Ramanan , Hofman Karen
Published: January 2018

Introduction

Excise taxes are policy tools that have been applied internationally with some success to reduce consumption of products adversely impacting population health including tobacco, alcohol and increasingly junk foods and sugary beverages. As in other low-income and middle-income countries, South Africa faces a growing burden of lifestyle diseases; accordingly we simulate the impact of multiple excise tax interventions in this setting.

Methods

We construct a mathematical model to simulate the health and revenue effects of increased excise taxes, which is adaptable to a variety of settings given its limited data requirements. Applying the model to South Africa, we simulate the impact of increased tax rates on tobacco and beer and of the introduction of a tax on sugar-sweetened beverages (SSB). Drawing on surveys of product usage and risk factor prevalence, the model uses a potential impact fraction to simulate the health effects of tax interventions.

Results

Adopting an excise rate of 60% on tobacco would result in a gain of 858 923 life-years (95% uncertainty interval (UI) 480 188 to 1 310 329), while adopting an excise rate of 25% on beer would result in a gain of 568 063 life-years (95% UI 412 110 to 775 560) and the adoption of a 20% tax on SSBs would result in a gain of 688 719 life-years (95% UI 321 788 to 1 079 653).

Conclusion

More aggressive excise tax policies on tobacco, beer and SSBs in South Africa could result in meaningful improvements in population health and raised revenue.
Performance of candidates disclosing dyslexia with other candidates in a UK medical licensing examination: cross-sectional study
Authors: Asghar Zahid B , Siriwardena Aloysius Niroshan , Elfes Chris , Richardson Jo , Larcombe James , Neden Katherine A , Salim Amer , Smalley David , Blow Carol
Published: January 2018

Purpose of the study

The aim of this study was to compare performance of candidates who declared an expert-confirmed diagnosis of dyslexia with all other candidates in the Applied Knowledge Test (AKT) of the Membership of the Royal College of General Practitioners licensing examination.

Study design

We used routinely collected data from candidates who took the AKT on one or more occasions between 2010 and 2015. Multivariate logistic regression was used to analyse performance of candidates who declared dyslexia with all other candidates, adjusting for candidate characteristics known to be associated with examination success including age, sex, ethnicity, country of primary medical qualification, stage of training, number of attempts and time spent completing the test.

Results

The analysis included data from 14 examinations involving 14 801 candidates of which 2.6% (379/14 801) declared dyslexia. The pass rate for candidates who declared dyslexia was 83.6% compared with 95.0% for other candidates. After adjusting for covariates linked to examination success including age, sex, ethnicity, country of primary medical qualification, stage of training, number of attempts and time spent completing the test dyslexia was not significantly associated with pass rates in the AKT. Candidates declaring dyslexia after initially failing the AKT were more likely to have a primary medical qualification outside the UK.

Conclusions

Performance was similar in AKT candidates disclosing dyslexia with other candidates once covariates associated with examination success were adjusted for. Candidates declaring dyslexia after initially failing the AKT were more likely to have a primary medical qualification outside the UK.
Relation Between Firing Statistics of Spiking Neuron with Delayed Fast Inhibitory Feedback and Without Feedback
Authors: Vidybida Alexander , Shchur Olha
Published: January 2018

We consider a class of spiking neuronal models, defined by a set of conditions typical for basic threshold-type models, such as the leaky integrate-and-fire or the binding neuron model and also for some artificial neurons. A neuron is fed with a Poisson process. Each output impulse is applied to the neuron itself after a finite delay [Formula: see text]. This impulse acts as being delivered through a fast Cl-type inhibitory synapse. We derive a general relation which allows calculating exactly the probability density function (pdf) [Formula: see text] of output interspike intervals of a neuron with feedback based on known pdf [Formula: see text] for the same neuron without feedback and on the properties of the feedback line (the [Formula: see text] value). Similar relations between corresponding moments are derived.

Furthermore, we prove that the initial segment of pdf [Formula: see text] for a neuron with a fixed threshold level is the same for any neuron satisfying the imposed conditions and is completely determined by the input stream. For the Poisson input stream, we calculate that initial segment exactly and, based on it, obtain exactly the initial segment of pdf [Formula: see text] for a neuron with feedback. That is the initial segment of [Formula: see text] is model-independent as well. The obtained expressions are checked by means of Monte Carlo simulation. The course of [Formula: see text] has a pronounced peculiarity, which makes it impossible to approximate [Formula: see text] by Poisson or another simple stochastic process.
EFFECTS OF HIGH- AND LOW-CUT FOOTWEAR ON THE KINETICS AND 3D KINEMATICS OF BASKETBALL SPECIFIC MOTIONS
Authors: SINCLAIR JONATHAN , SANT BENJAMIN
Published: January 2018

The aim of the current investigation was to examine the effects of high- and low-cut basketball-specific footwear, in relation to minimalist and conventional athletic footwear, on the kinetics and three-dimensional (3D) kinematics of sport-specific basketball movements. Ten males performed run and 45[Formula: see text] cut movements, whilst wearing low-cut, high-cut, minimalist and conventional athletic footwear. 3D kinematics of the lower extremities were measured using an eight-camera motion analysis system, alongside the vertical rate of loading, which was obtained using an embedded force platform. Footwear differences in 3D kinematic and loading rate parameters were examined using 4 (footwear) [Formula: see text] (movement), repeated measures ANOVA. The results showed that loading rate was significantly larger in the minimalist footwear ([Formula: see text] and [Formula: see text][Formula: see text]BW/s), in relation to the low-cut ([Formula: see text] and [Formula: see text][Formula: see text]BW/s), high-cut ([Formula: see text] and [Formula: see text][Formula: see text]BW/s) and conventional ([Formula: see text] and [Formula: see text][Formula: see text]BW/s) conditions. In addition, it was also revealed during the run movement that peak angles of eversion were reduced significantly when wearing the high-cut ([Formula: see text]) footwear, compared to the low-cut [Formula: see text], minimalist [Formula: see text] and conventional [Formula: see text] conditions. The findings from the current investigation indicate that from an injury prevention context, conventional athletic footwear may be most appropriate for basketball players who are susceptible to chronic impact-related injuries, and high-cut footwear may be most suitable for players who require additional medial/lateral ankle stability.
Influence of Distal Stenosis on Blood Flow Through Coronary Serial Stenoses: A Numerical Study
Authors: Liu Biyue , Tang Dalin
Published: January 2018

Computer simulations of the blood flow through right coronary arteries with two stenoses in the same arterial segment are carried out to investigate the interactions of serial stenoses, especially the effect of the distal stenosis. Various mathematical models are developed by varying the location of the distal stenosis. The numerical results show that the variation of the distal stenosis has significant impact on coronary hemodynamics, such as the pressure drop, flow shifting, wall shear stress and flow separation. Our simulations demonstrate that the distal stenosis has insignificant effect on the disturbed flow pattern in the regions of upstream and across the proximal stenosis. In a curved artery segment with two moderate stenoses of the same size, the distal stenosis causes a larger pressure drop and a more disturbed flow field in the poststenotic region than the proximal stenosis does. A distal stenosis located at a further downstream position causes a larger pressure drop and a stronger reverse flow.
Magnetic and dielectric properties of Fe3BO6 nanoplates prepared through self-combustion method
Authors: Kumari Kalpana
Published: January 2018

In the present investigation, a facile synthesis method is explored involving a self-combustion of a solid precursor mixture of iron oxide Fe2O3 and boric acid (H3BO3) using camphor (C[Formula: see text]H[Formula: see text]O) as fuel in ambient air in order to form a single phase Fe3BO6 crystallites. X-ray diffraction (XRD), Field emission electron microscopy (FESEM), magnetic, and dielectric properties of as prepared sample are studied. From XRD pattern, a single phase compound is observed with an orthorhombic crystal structure (Pnma space group), with average crystallite size of 42[Formula: see text]nm. A reasonably uniform size distribution of the plates and self-assemblies is retained in the sample. A magnetic transition is observed in dielectric permittivity (at [Formula: see text]445[Formula: see text]K) and power loss (at [Formula: see text]435[Formula: see text]K) when plotted against temperature. A weak peak occurs near 330[Formula: see text]K due to the charge reordering in the sample. For temperatures above the transition temperature, a sharp increase of the dielectric loss is observed which occurs due to the presence of thermally activated charge carriers. A canted antiferromagnetic Fe[Formula: see text] ordering in a Fe3BO6 lattice with a localized charge surface layer is an apparent source of exhibiting a ferroelectric feature in this unique example of a centrosymmetric compound. An induced spin current over the Fe sites thus could give rise to a polarization hysteresis loop. Due to the presence of both ferromagnetic as well as polarization ordering, Fe3BO6 behaves like a single phase multiferroic ceramics.
AN INCLUSIVE CRITERION FOR AN OPTIMAL CHOICE OF REINSURANCE
Authors: ABDERRAHIM EL ATTAR , MOSTAFA EL HACHLOUFI , ABIDINE GUENNOUN ZINE EL
Published: January 2018

In this paper, we propose an inclusive model which allows to improve the results obtained in the literature with regard to the criteria set by the insurers such as, maximizing the expected technical benefit under the variance constraint (mean-variance), minimizing the probability of ruin and minimizing risk measures. In this model, we determine the optimal reinsurance treaty parameter that minimizes both the risk and the probability of ruin (by maximizing the Lundberg adjustment coefficient) under the constraint of the technical benefit which must also be maximal, based on the conditional tail variance (CTV) risk measure. Thus, we have developed an optimization procedure based on the augmented Lagrangian and genetic algorithms, in order to solve the optimization program of this model.
Tupistra cardinalis (Asparagaceae), a new species from limestone areas in northern Vietnam
Authors: AVERYANOV LEONID V. , TANAKA NORIYUKI , SON HOANG THANH , NGUYEN KHANG SINH , MAISAK TATIANA V. , NGUYEN TIEN HIEP , PENG CHING-I
Published: January 2018

Tupistra Ker Gawler (1814: 1655), which was later recircumscribed by Tanaka (2003a, 2010a), belongs to Nolinoideae of Asparagaceae (APG 2009, Chase et al. 2009). It comprises about 30 species (Tanaka 2010a, Averyanov et al. 2017, Govaerts 2017, Nguyen et al. 2017, Roy et al. 2017, Tanaka et al. 2017) distributed widely over subtropical to tropical Asia, covering Bangladesh, Bhutan, China, India, Indonesia, Laos, Malaysia, Myanmar, Nepal, Thailand, and Vietnam (Tanaka 2010a, Averyanov & Tanaka 2012, Hu et al. 2013, Vislobokov et al. 2014, Averyanov et al. 2015, 2016, 2017, Nguyen et al. 2017, Roy et al. 2017).
Prevention and Management of Antineoplastic Extravasation Injury
Authors: Mullin Shantel , Beckwith M. Christina , Tyler Linda S.
Published: January 2018

Goal

The goal of this program is to inform the participant of practical ways to prevent, identify, and manage the extravasation of anti-neoplastic agents.

Objectives

At the completion of this program the participant will be able to: 1. List antineoplastic agents known to be vesicants or irritants. 2. Identify the signs and symptoms of extravasation injury. 3. Recommend a procedure for the safe administration of vesicant medications. 4. Describe the appropriate management of antineoplastic-induced extravasation injury.
Quinupristin/Dalfopristin
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The February 2000 Formulary monographs are on gatifloxacin, moxifloxacin, levetiracetam, aspirin/extended-release dipyridamole, and aminolevulinic acid HCl. The DUE is on gatifloxacin.
Methylprednisolone as a Cause of Anaphylaxis Diltiazem-Induced Tetany NSAID-Induced Colonic Stricture with Ulceration and NSAID-Induced Erythema Multiforme amotrigine and Tourette Symptoms Anaphylactic Reaction after Dermal Exposure to Cephalexin
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Topotecan for Ovarian Cancer and Small-Cell Lung Cancer
Authors: Styles Jennifer R. , Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
This CE is published through an unrestricted educational grant from Bristol-Myers Squibb
Authors: Chandramouli Jane , Tyler Linda S , Hoffman Jennifer M.
Published: January 2018

Credit

This lesson is good for 0.2 CE units, with a passing grade of 70%.

Goal

The goal of this program is to inform the participant about common types of malignant gliomas and to discuss new treatment modalities.

Objectives

At the completion of this program the participant will be able to: 1. Identify the standard types of treatment for primary brain tumors 2. Explain the pharmacology of temozolomide and irinotecan 3. List the most common adverse effects associated with temozolomide and irinotecan 4. Determine appropriate monitoring and provide dosing adjustments
Continuation of Drug Therapy
Authors: Vance Holly
Published: January 2018

Collaborative drug therapy management (CDTM) is a method for developing a patient-centered practice in which the pharmacist's activities are integrated with those of other health care providers. The goals of this continuing feature are to refine the concept of CDTM and provide patient-care applications from the authors' experience in Washington state. Questions or suggestions should be addressed to Timothy S. Fuller, FASHP, Fuller and Associates, 1948 Boyer Avenue East, Seattle, WA 98112-2924 (tel. 206-860-8308).
Combined Alteplase and Eptifibatide Lead to Death and Coma in Two Incidents More on Sleep Attacks with Pramipexole More on Avoiding Thrombocytopenia Caused by Heparin Flushes Morbidity from Non-Potassium-Sparing Diuretics
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Antibiogram Development for an Outpatient Dialysis Center
Authors: Manley Harold J. , Bailie George R. , Neumann Marianne
Published: January 2018

Infection causes significant morbidity and mortality in end-stage renal disease patients. Despite recommendations to the contrary, vancomycin is often used empirically. Antibiograms may aid in the choice of empiric antibiotic therapy. We developed an antibiogram and determined the susceptibility of various microorganisms to cefazolin, gentamicin, and vancomycin. Retrospective review of culture results and susceptibility data from a 21-month time period were used to determine microorganism frequency of identification and antimicrobial sensitivity. A total of 362 microorganisms were identified and 285 cultures performed in 171 patients (144 hemodialysis; 27 peritoneal dialysis). Predominant organisms were coagulase-negative staphylococci (39.8%) and Staphylococcus aureus (24.6%). Gram-positive organisms accounted for 73.5% of isolates. Methicillin-resistant S. aureus and vancomycin-resistant Enterococcus were identified 3.8% and 2.3% of time, respectively. Gram-positive and negative microorganisms were frequently susceptible to cefazolin and gentamicin. Antibiogram interpretation indicates that cefazolin alone or in combination with gentamicin may be appropriate empiric antibiotic therapy in our outpatient dialysis center.
Monitoring the Storage Temperature of Ambulance Medications with Time-Temperature Indicators
Authors: Allegra John , Brennan John , Fields Laura , Grabiner Frederick , Kiss George , Lavery Robert , Prusik Thaddeus
Published: January 2018

The US Pharmacopeia gives recommendations for the storage of pharmaceuticals in terms of mean kinetic temperature (MKT). This study's goal was to determine if color-changing time–temperature indicator (TTI) labels can reliably monitor the MKTs of medications used in ambulances. TTI labels and miniature electronic temperature recorders were placed into the drug storage boxes in five advanced life support units over 12 summer weeks in 1995 and in three advanced life support units over 4 weeks the following winter. The electronic temperature recorders measured temperatures several times per hour, and the color changes of the TTI labels were analyzed periodically. The MKTs calculated from the TTI labels differed from those calculated from the electronic temperature recorders in all cases by less than 1° C. The authors concluded that TTIs can accurately measure the MKTs of medications used in ambulances. A TTI label on each medication container may help insure that drugs are not damaged by temperture conditions.
Drug Samples in Depth
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Making it Easier for Nurses to Identify Patients before Administering Medications Cafcit Label Easy to Misread Preventing Misunderstandings When Accepting Oral Requests for Drug Information Caution: 30 mL Vials of Topical and Injectable Adrenalin are Nearly Identical
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute of Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Health Information Privacy: On the Top of the Political Agenda (Part 1 of 2)
Authors: Bogen Jonathan D. , Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Prescriber Computer Order Entry: Team Structure and Physician Impact
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center.
Visits to Hospital Outpatient Departments in the United States Due to Adverse Effects of Medications
Authors: Aparasu Rajender R. , Helgeland David L.
Published: January 2018

Using 1995–1996 National Hospital Ambulatory Medical Care Surveys, this study examined the prevalence, nature, and demographics of visits to hospital outpatient departments (OPDs) for adverse effects of medications, and the resource utilization associated with these visits. Weighted analyses of visits resulting in principal diagnoses of adverse effects of medications revealed that 0.19% of OPD visits were due to such incidents. These estimates projected annually represent 125,508 visits or 4.77 visits per 10,000 persons. The highest visit rates were seen in females, patients over 74 years old, and patients living in the Midwest. The agents most often responsible for these visits were hormones, antibiotics, and analgesics. The most frequently cited reasons for the visits were adverse effects of medications and skin rashes. Many medication-related OPD visits require diagnostic services and pharmacotherapy, thus a reduction in these problems would decrease the burden on health care systems.
Management of Adult Heart Failure: Bolus versus Continuous Infusion Loop Diuretics, A Review of the Literature
Authors: Ravnan Susan L. , Ravnan Marcus C.
Published: January 2018

In an aging population, decompensated heart failure accounts for a significant number of hospital admissions. The standard management for edema and congestion associated with heart failure is loop diuretic therapy. Traditionally, bolus-dosed furosemide has been used to manage the edema and congestion associated with heart failure. However, diuretic resistance can occur with bolus dosing, resulting in inadequate diuresis and further hemodynamic instability. Based on current literature, furosemide given by continuous infusion may now be the preferred agent and route for diuretic refractory heart failure. This article reviews the literature that compares bolus versus continuous infusion loop diuretics in adult heart failure.
A Survey of Fee-for-Service Activities of Drug Information Centers
Authors: Nathan Joseph P. , Rosenberg Jack M.
Published: January 2018

A survey was conducted to evaluate the fee-for-service (FFS) activities of drug information centers (DICs). Questionnaires were sent to 103 DICs across the United States. Centers were queried about funding source(s), percentage of funds obtained from fees-for-service, fee schedules and rates, and changes in revenue over the previous 5 years. Hospitals, universities, fees, grants, pharmaceutical companies, and unspecified source(s) were reported as funding source(s). Seventeen (22.4%) of the 76 responding DICs reported obtaining revenue from service fees; these DICs utilized various fee schedules and rates, including annual rates, hourly rates, per request charges, and a “900” toll phone line. Of the DICs that reported FFS revenue, nine centers (52.9%) ranked their sources. An increase, decrease, or no change in FFS revenue over the past 5 years was reported by eight centers (47.1%), two centers (11.8%), and seven centers (41.2%), respectively. It was concluded that the FFS activities of DICs have remained essentially unchanged over the past 2 decades.
Verifying Carboplatin Dose Calculations in Adult Patients with the Calvert and Modified Calvert Formulas
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Linezolid
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The September 2000 Formulary monographs are tegaserod, insulin aspart, tiptorelin pamoate, ziconotide, and bexarotene gel. The DUE is on low-molecular weight heparins and heparinoid.
Prescriber Computer Order Entry: System Design
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of CPOE at the Medical Center.
Tenecteplase
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The October 2000 Formulary monographs are argatroban, tinzaparin sodium, balsalazide, methylphenidate extended-release tablets, and eflornithine hydrochloride cream. The DUE is on argatroban.
Impact of a Drug Information Service: Practitioner Hours Saved
Authors: Marrone Christopher M. , Heck Amy M.
Published: January 2018

Objective

To determine the workload and impact of a drug information (DI) inquiry service by measuring the number of Practitioner Hours Saved (PHS) and the associated monetary value.

Methods

During a 3-month study period, the time required to respond to DI requests was recorded to determine the PHS for all questions. Total PHS by practitioner type was determined and then totaled for all questions. Economic impact was estimated by multiplying PHS by the requesting practitioner's salary.

Results

A total of 308 responses were included in the 3-month study period analysis, which represented 266 PHS. This time-savings represented an estimated economic impact of $10,987, which can be extrapolated to $43,950 for a 1-year period.

Conclusions

PHS can be used to show the estimated value of one service component provided by a DI service to the health care system. It is a good measure of estimated practitioner time-savings provided by use of DI services and can be used to record workload statistics.
Pharmacy Issues: Drug Nomenclature
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center.
Cost-Benefit Analysis of a Clinical Pharmacist's Presence on a Post-Liver Transplant Service (Confessions of Some Accidental Hermeneuticians)
Authors: Brethauer Brenda , Devine Beth , Jue May , Quan David , Louie Clifton
Published: January 2018

The authors used a novel analytical lens to justify the placement of a clinical pharmacist on an inpatient unit within an academic health center. From a financial cost–benefit perspective, we found that the assignment of a clinical pharmacist had a positive return of approximately $65,000. By coupling the financial analysis with another interesting evaluation method—hermeneutics— we were able to interpret the nontangible constraints that may be preventing support for the clinical pharmacy service. By mitigating the nontangible constraints, we hope to increase the hospital administrator's willingness to accept the program.
The Hospital Pharmacist as an Expert Witness
Authors: Van Dusen Virgil , Pray W. Steven
Published: January 2018

An expert witness provides knowledge from his or her field of specialization to participants in a trial, to help them clarify the issues presented to them. The hospital pharmacist is a natural choice as an expert witness in cases of alleged negligence within the hospital pharmacy. The hospital pharmacist who intends to become an expert witness should consider issues such as credentialing, obtaining employment, and developing a fee schedule. From the outset, the expert witness must keep accurate records, and he or she may be called upon to review documents, write opinions, render affidavits, and assist attorneys in questioning opposing experts. The expert witness may also create documents and may testify during a deposition. The culmination of the process is the trial itself, in which the expert must strive to present issues clearly and professionally, during both the direct examination and the cross-examination. The trial may be won, lost, or settled out of court — and this outcome can be influenced by the testimony rendered by the expert witness.
Cancer Chemotherapy Update: Fluorouracil and Low-Dose Leucovorin (Mayo Regimen) for Advanced Colorectal Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
• Childhood Poisonings and Harmful Effects of otc Drugs in the Unborn /• Vancomycin-Induced Neutropenia/ • Two Cases of Drug-Induced Hepatitis: Lamotrigine and Bupropion are the Culprits/ • Impotence Caused by Haloperidol
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers
Questions and Answers from the F.I.X./• Digibind in Chronic Digoxin Dosing /• Fosphenytoin (Cerebyx) Use in Dialysis Patients/ • MMR vs MR/ • Insulin Drip Protocol/ • Tobramycin Powder Alternatives
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X.
Hospital and Pharmacy Departmental Policies and Procedures for Gene Therapy at a Teaching Institution
Authors: Armitstead John A. , Zillich Alan J. , Williams Kristal L. , Sitzlar Stephen C. , Wermeling Dan
Published: January 2018

Gene therapy is an emerging, promising field in health care. Although still in investigational trials, gene therapy offers utility in a variety of disease states. This article details hospital and departmental policies and procedures for gene therapy research at a teaching institution. These preliminary guidelines identify the standards of practice at one institution in 1999 and will be refined as systems of practice develop. The guidelines, which exemplify the types of precautions necessary for safely utilizing gene therapy, may be useful to other institutions in the process of developing their own policies.