bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of the Impact of Medication Therapy Management Delivered to Home-Based Medicare Beneficiaries
Authors: Welch Erin K , Delate Thomas , Chester Elizabeth A , Stubbings Troy 
Published: March 2009

Background: Medication Therapy Management (MTM) is a voluntary patient participation program mandated for Medicare Part D sponsors by the Centers for Medicare and Medicaid Services for chronically ill beneficiaries with high medication costs/utilization. Objective: To assess the impact of an MTM program on mortality, healthcare utilization, and prescription medication costs and to quantify drug-related problems (DRPs) identified during MTM. Methods: This nonrandomized controlled study was conducted among beneficiaries who were targeted for MTM in 2006. The MTM intervention was designed to identify potential DRPs, educate the patient/caregiver about appropriate medication use, and ensure that the patient was appropriately integrated into clinical services. Data were collected from administrative databases and manual chart abstractions. Study outcomes included all-cause death (primary outcome), hospitalization, and emergency department (ED) visit rates and medication cost changes in the 180 days following MTM targeting and quantification of DRPs. Multivariate logistic regression was used to adjust the outcomes for baseline risk and other potential confounders. A mock MTM intervention was performed for beneficiaries who declined MTM and died, were hospitalized, and/or made an ED visit. Results: A total of 459 opt-in and 336 opt-out beneficiaries who agreed and declined, respectively, to receive MTM were included in the analysis. Beneficiaries who opted in were less likely to die compared with beneficiaries who opted out (adjusted OR [AOR] 0.5; 95% CI 0.3 to 0.9) but were more likely to have had a hospitalization (AOR 1.4; 95% CI 1.1 to 2.0) and an increase in medication costs (AOR 1.4; 95% CI 1.1 to 1.9) during follow-up. There was no difference in ED visit rates. At least one DRP was identified in more than 83% of beneficiaries in both groups, with the most common DRP being drug–drug interaction. Conclusions: Our investigation supports the use of MTM, with its increased coordination of information between healthcare providers and patients, since it may impact mortality positively in a population of high-risk Medicare beneficiaries.
Efficacy and Safety of Modafinil in the Treatment of Cancer-Related Fatigue
Authors: Cooper Maryann R , Bird Heather M , Steinberg Michael 
Published: March 2009

Objective: To review the efficacy and safety of modafinil in the treatment of cancer-related fatigue (CRF). Data Souces: Literature was accessed via MEDLINE (1950–week 3, November 2008), International Pharmaceutical Abstracts, and Google Scholar using the terms modafinil, cancer, and fatigue. Reference citations from articles identified were reviewed. Study Selection and Data Extraction: All English-language publications identified were analyzed for significance. Studies relevant to the objective were used, including 2 prospective open-label studies, one randomized double-blind, dose-controlled trial with an open-label extension, and one Phase 3 randomized, placebo-controlled, double-blind trial. Data Synthesis: Fatigue is a nearly universal adverse effect of cancer and its treatment that is unrelated to physical exertion, is not relieved by sleep or rest, and negatively affects quality of life. Modafinil is a central nervous system stimulant with minimal toxicity and a low propensity for abuse. Clinical data demonstrate that modafinil significantly reduces fatigue in patients who have received cancer treatment or are currently undergoing chemotherapy. Additional benefits include improvement in cognitive function, mood, general activity, walking ability, normal work ability, relations with other people, and enjoyment of life. Limitations of the available data include open-label design in 3 of the 4 studies; the absence of numerical results of fatigue assessments in the abstract of 1 trial, preventing the determination of clinical significance; and the full inclusion/exclusion criteria, which were not included in the published abstracts. These limitations leave readers without a clear picture of the study populations. Finally, different patient populations at different points in treatment with varying durations of therapy were used, which makes extrapolation of data to the general population challenging. Conclusions: Further randomized placebo-controlled trials are necessary to amass evidence for the effective and safe use of modafinil for CRF; however, if traditional therapies have failed or are intolerable, modafinil can be considered a treatment option.
Risk of Severe Gastrointestinal Events in Women Treated with Monthly Ibandronate or Weekly Alendronate and Risedronate
Authors: Blumentals William A , Harris Steven T , Cole Raymond E , Huang Liping , Silverman Stuart L 
Published: March 2009

Background: Bisphosphonate (BP)-related gastrointestinal (Gl) adverse events can lead to discontinuation of osteoporosis treatment. Irritation of the GI tract related to BPs may be worsened by more frequent administration. Objective: To compare the number of women who experienced severe GI events within 3 months of starling once-monthly oral ibandronate with those starting once-weekly oral BP (alendronate or risedronate). Methods: In a retrospective database study design, eligible women with a new prescription for monthly ibandronate were propensity-matched to women with a new weekly BP prescription. Patients had continuous health plan enrollment for 6 months prior to the index date and for 3 months after the index date. Women with previous intravenous BP treatment, Paget's disease, or oral BP treatment within the 6-month preindex period were excluded. Severe GI events (including acute events involving perforation or bleeding/perforation) within 3 months of treatment initiation were identified by ICD-9 and Current Procedural Terminology codes. A post hoc analysis assessed treatment discontinuation after severe GI events. GI-related healthcare utilization rates and costs were also compared, Results: Of the 8608 patients per group, 45 (0.52%) who were receiving monthly ibandronate and 70 (0.81%) of those receiving weekly BP treatment experienced a severe GI event. Ibandronate patients had a 36% reduction in the risk of severe GI events compared with weekly BP users (OR 0.64, 95% CI 0.44 to 0.93). Significantly more women receiving a weekly BP discontinued treatment after a severe GI event compared with those receiving ibandronate (100% vs 55.6%: p< 0.001). Most healthcare utilization outcomes were not significantly different between the 2 groups; outpatient visits were significantly higher for ibandronate (p = 0.02). Costs were not significantly different between the 2 groups. Conclusions: Patients receiving monthly ibandronate therapy had a significantly reduced risk of severe GI events compared with those receiving weekly BP treatment. In addition, patients receiving a weekly BP were more likely to discontinue treatment after a severe GI event.
Patient Needs and Sources of Drug Information in Singapore: Is the Internet Replacing Former Sources?
Authors: Ho Cai-Hong , Ko Yu , Tan Mui-Ling 
Published: March 2009

Background: Patients are exposed to a broad range of drug information (DI) sources; among them is the Internet, which has been increasingly used over the years, especially by adolescents. Objective: To identify patients' needs and common sources of DI: examine the differences in use of DI sources among groups, by age and sex; and better understand patients' use of the Internet as a source of DI. Methods: A quota sample of 201 outpatients from National University Hospital in Singapore was surveyed. A questionnaire was developed to examine patients' needs for and common sources of DI as well as their experience with and attitudes toward using the Internet as a DI source. Results: Physicians (83.1%) and pharmacists (57.7%) were reported to be the most commonly used sources of DI regarding prescription drugs (n = 201), whereas pharmacists (40.9%) and relatives or friends (40.9%) were the most commonly reported sources for information about nonprescription drugs (n = 149). Respondents most commonly sought DI about adverse effects (72.6%), dosing (54.7%), and indications (54.2%). Among Internet users, people aged 31–50 years were more likely than those in other age groups to search the Internet for DI (p < 0.001). The Internet was considered to be a convenient source with a broad range of information; however, patients faced both the inability to find needed information and uncertainty about information reliability when searching (or DI on the Internet. Conclusions: Pharmacists play an important role in counseling patients about prescription and nonprescription drugs. There is a need to educate patients on how to locate and evaluate DI on the Internet.
Sustaining Ambiguity and Fostering Openness in the (Design) Learning Environment
Authors: Valentine Louise , Ivey Marlene 
Published: March 2009

Knowledge economies possess a number of key characteristics that require designers to work and cope with the growing occurrence of unpredictable scenarios. To mindfully engage in an uncertain world, student designers must develop critical thinking, social interaction and the ability
to manifest design in a diversity of professional and industrial sectors. They need to develop the ability to equip themselves with the skill of sustaining and renewing knowledge throughout their careers. This demands that design extend its teaching beyond revealing the origins and nature
of design to include skills of interrogation, which allow individuals to challenge existing and established theories and practices.
The intention of this paper is to articulate a teaching and learning philosophy for contemporary design, and exemplify practice through design projects and
skill development from one postgraduate design programme. It discusses the philosophy of mindfulness and refers to the activities of rhetoric and visual thinking as means of nurturing communication of the designer's thinking. The nature rather than the content of teaching and learning
is of key concern, and as such the practicalities of teaching and applying mindful learning are referred to but purposefully not described, analysed or argued for. In closing, a new strategy for design teaching and learning is proposed.
Characterization of Locked Sand from Northeastern Alberta
Authors: Abdelaziz Tarek S. , Derek Martin C. , Chalaturnyk Rick J. 
Published: March 2009

Abstract
A comprehensive experimental investigation was carried out on a lower Cretaceous friable intact sand formation retrieved from northeastern Alberta. Index tests, microstructural observations, and mineralogical composition analyses were carried out to confirm that this formation fits into the locked sand category. The significance of the local strain measurements in revealing salient deformation characteristics of this formation was explored under uniaxial stress conditions. The test results showed that the characteristics of this formation are in keeping with the characteristics of locked sands. The intimacy between the grains stems from authigentic quartz creating interlocking rather than cementation. The results also revealed that local axial and lateral strain measurements are essential for proper behavioral characterization and failure mechanism interpretation of locked sands. The interlocked fabric results in an exceptionally high uniaxial strength and elastic axial stiffness. The disruption of the interlocking is achieved through the lateral expansion of the sample and formation of dilation bands.
Effects of Particle Shape and Gradation on the Results of Miniature DCP Tests in Sand
Authors: Muszynski Mark R. 
Published: March 2009

Abstract
Miniature dynamic cone penetrometer (mDCP) tests were completed to investigate the general effect that particle shape and size gradation may have on penetration resistance. This testing provides preliminary results for planning purposes for a future testing program that will include full-scale dynamic cone penetrometer (DCP) testing on sands having varying physical properties and characteristics. Generally, the blow counts per increment became greater with increasing relative density for dry and moist sands, as expected. Angular sands increased the blow counts, whereas rounded sands yielded lower blow counts for the same relative density and grain size distribution. At high relative densities, the effect of particle shape was generally more pronounced than at lower relative densities for a specimen of given particle shape. Gradation appeared to have an effect for the moist specimens, although a defined trend was not observed. The moist specimens exhibited greater resistance penetration than did the oven dry specimens. Scale effects are discussed and considerations for future full-scale testing are identified.
Review of Specific Local Fenestration Units, Building Envelope Interface Practices, and Materials Compared to ASTM E 2112, Current Acceptance Criteria, and Evaluation Practices
Authors: Ackerman DS 
Published: March 2009

Abstract
1. Variations in physical installation environments
a. Weather variations in Washington
b. Types of construction and materials used
c. Weather impact on interface materials and exposure periods
d. Installation practices during varying conditions
2. Installation of windows and flashing in single and multifamily projects in the Northwest
a. Divergence of methods between locations and type of construction
b. Agency requirements and inspections
c. Architect construction plan specifications
d. Practice compared to window manufacturers and E2112 specifications
e. Common Installation Problems Caused By Window Installers
f. Practical considerations, standards vs. the real world
f. Window manufacturer's instruction, guidance and training
h. Flashing observations encountered in the development of a new product
3. Consideration of current Acceptance Criteria and Evaluation Reports
Evaluation of the Embrittlement of Pressure Vessel Steels Irradiated in JPDR
Authors: Kawasaki M , Fujimura T , Suzuki K , Namatame H , Kawasaki M 
Published: March 2009

Three surveillance programs of the JPDR pressure vessel have been performed to date. From the assessment of both the shift of NDT temperature and the reduction of upper shelf energy in the pressure vessel steel due to irradiation, it was concluded that the pressure vessel could be used with safety for about ten years at equivalent full power (45 MWt) operation.
A reference test was also performed on two potential steels for pressure vessel use, namely a Mn-Mo-0.4∼0.7Ni steel (A533B Class 1) and a 2 1/4Cr1Mo (A542 Class 1) steel, following the completion of the surveillance test. The latter steel was found to be much less sensitive to irradiation than the former. The weld metal and heat affected zone are somewhat more sensitive to irradiation than the base metal for the 2 1/4Cr-1Mo steel submerged arc weldment.
The Fatigue Strength of Nickel-Base Superalloys
Authors: Gell M , Leverant GR , Wells CH 
Published: March 2009

The service lives of nickel-base superalloy components in gas turbine engines are frequently limited by their fatigue properties. This paper reviews what is known about the fatigue behavior of nickel-base superalloys and suggests methods for improving their properties. Low-temperature crack initiation occurs preferentially at microstructural defects such as pores and brittle phases in cast materials and at defects such as brittle phases and annealing twin boundaries in wrought materials. The brittle phases may contain inherent cracks or be cracked during working operations or service exposures. Plastic deformation at low temperatures is concentrated in coarse planar bands, and as a result matrix cracking is predominantly transgranular and crystallographic. Techniques are discussed for increasing the low-temperature fatigue properties by minimizing the role of microstructural defects and achieving a more homogeneous distribution of deformation.
At elevated temperatures, intergranular cracking predominates and methods are discussed for improving fatigue properties through grain size control, the use of columnar-grained and single-crystal materials, and the application of oxidation-resistant and fatigue-resistant coatings.
Effect of Temperature and Pressure on Cavitation Damage in Sodium
Authors: Young SG , Johnston JR 
Published: March 2009

Three materials with widely different mechanical properties, L-605, Stellite 6B, and AISI 316 stainless steel were subjected to accelerated cavitation damage in sodium at 800 F (427 C). L-605 was tested also at 400 F (204 C) and 1200 F (649 C). A magnetostrictive vibratory apparatus was used. Argon was introduced over the liquid sodium to maintain pressures ranging from 1 to 4 atm (1 to 4 × 105 N/m2). Cavitation damage was determined by volume loss measurements, and metallographic studies were made.
It was found that increasing pressure significantly increased cavitation damage to all materials at all temperatures tested. When the volume-loss-rate data were normalized to consider only the heavily damaged area of the specimens, the average volume loss rate increased as a power function of pressure (at pressures above approximately 2 atm (2 × 105 N/m2)). This result of increasing damage with increasing pressure implies that, in fluid systems where cavitation occurs in high pressure regions, damage to components may be much greater than would be expected normally from cavitation tests conducted at atmospheric pressure. L-605, the one material tested at all three temperatures and all four pressures, exhibited greater damage at 800 F (427 C) than at 400 F (204 C), or 1200 F (649 C) at all pressures.
At 800 F (427 C) the single temperature at which all materials were tested over the entire range of pressures, the relative ranking of the materials with respect to resistance to cavitation damage was the same regardless of pressure. In order of increasing damage, it was Stellite 6B, L-605, and AISI 316 stainless steel. This result, together with the fact that the damage rate increased with increasing pressure, suggests that laboratory cavitation damage testing can be greatly accelerated by conducting such tests at higher pressures.
Metallographic examination of axially sectioned specimens of all the materials tested at 800 F (427 C) revealed severe undercutting of the surface and transgranular cracking. Surface deformation was indicated by the appearance of slip bands in all materials after testing at 800 F (427 C). Stellite 6B showed extensive cracking of carbides beneath the surface, and L-605 exhibited some bending of twins near the surace.
Toward Quantitative Prediction of Liquid Impact Erosion
Authors: Heymann FJ 
Published: March 2009

There still exists no objective measurement of the erosion resistance of a material, nor a theory for predicting the material loss to be expected under given service conditions, based on any generally accepted hypotheses concerning the erosion damage mechanisms. This paper presents an approach which does not presuppose any specific mechanisms but rather is based on empirical data and dimensional considerations.
First, a “normalized erosion resistance” (Ne) of a material is defined which allows direct comparison of many different test results, including cavitation tests, and provides a quantitative measure of erosion resistance even though that is not yet a physically understood property. One finds that the values of Ne for metals vary from about 0.03 for soft aluminum to about 60 for some stellites and hard tool steels; total range of about 2000:1. Neither hardness nor strain energy or other independent parameters prove to be reliable indexes to erosion resistance.
In order to develop a quantitative formula for predicting impingement erosion, the “rationalized erosion rate” (Re) is defined as the ratio of volumetric material loss rate to the volume rate of liquid impingement. Previous studies have suggested that this quantity should be proportional approximately to the fifth power of impact velocity.
Plotting NeRe for a number of experimental results versus normal impact velocity Vo (m/s) confirms the power law and yields two approximate relationships: NeRe = (Vo/2550)5.05 for impact against droplets, and NeRe = (Vo/2920)4.37 for impact against cylindrical jets.
Some of the physical hypotheses which have been proposed for the prediction of erosion damage, particularly those based upon the concept of energy transfer from the impinging liquid to the eroding surface, are examined for consistency with these findings, and tests with different liquids are found to be necessary to resolve this question.
Effects of Notches and Saltwater Corrosion on the Flexural Fatigue Behavior of High-Strength Structural Alloys
Authors: Schwab RC , Czyryca EJ 
Published: March 2009

The effects of mechanical notches and saltwater corrosion on the flexural fatigue behavior of seven high-strength structural alloys were investigated over a broad life range of 1,000 to 100 million cycles. The seven alloys (three ferrous, three titanium, and one aluminum) had approximately the same ratio of yield strength to density.
Results showed that notches were most damaging in the high-cycle life range, and that only titanium alloys exhibit a fatigue limit when subjected to corrosion fatigue. When compared on the basis of fatigue strength in air, the high-strength steels are superior over the entire life range. If, however, comparisons are made on the basis of ratio of fatigue strength to density, all seven alloys are approximately equal. The comparison of fatigue strength and ratio of fatigue strength to density over the broad life range for corrosion fatigue shows the titanium alloys to be superior at intermediate and long lives.
The Charpy Impact Test—Its Accuracy and Factors Affecting Test Results
Authors: Fahey NH 
Published: March 2009

The Army Materials and Mechanics Research Center, AMMRC, (formerly Watertown Arsenal Laboratories) has managed a program for many years on the certification of Charpy impact machines. During this period, approximately 200 machines have been evaluated annually.
This paper is a compilation of the findings of these certification tests. What is evident is that each model machine possesses its own characteristic weaknesses which, unless controlled, can easily result in erroneously high test values. It is estimated that approximately half of the machines in use today are producing values well in excess of the limits set in Army specifications; that is, plus or minus 5 percent or 1.0 ft∙lb, whichever is the greater. Since most discrepancies either slow down the pendulum or result in absorptional losses, the value recorded includes energy not expended in fracturing the specimen, thus creating a false sense of security for the investigator or design engineer.