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Pedagogical laboratory experiments highlighting the interdisciplinary nature of chemistry and art

Castel, L. D.

Campbell University
CU FIND
Business, Lundy-Fetterman School of Faculty Research and Publications
2019
Introducing the first articles of the veterans and
military patient-related health outcomes thematic
series
L. D. Castel
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Part of the Medicine and Health Sciences Commons
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Recommended Citation
Castel, L. D., "Introducing the first articles of the veterans and military patient-related health outcomes thematic series" (2019).
Business, Lundy-Fetterman School of. 39.
https://cufind.campbell.edu/business/39
© 2019 Castel. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. 
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Patient Related Outcome Measures 2019:10 81–82
Patient Related Outcome Measures Dovepress
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Dovepress 
81
E d i t O R i a l
open access to scientific and medical research
Open Access Full Text Article
http://dx.doi.org/10.2147/PROM.S204114
Introducing the first articles of the veterans and 
military patient-related health outcomes thematic 
series
liana desHarnais Castel1,2
1Lundy-Fetterman School of Business, 
Campbell University, Buies Creek, 
NC, USa; 2Clinical Performance 
and Quality, Cigna Health and Life 
insurance Company, Raleigh, NC, USa
Modern medicine and scientific research owe a special debt to the care and well-being 
of service personnel who endure, sometimes multiple, deployments in times of war 
and conflict. The intense nature of violent conflict, isolation and distance from their 
family and home, and exposure to harsh conditions and chemicals puts these popula-
tions at risk for both acute and chronic, often lifelong adverse patient-related physical 
and mental health outcomes.
In 2018 the Editors of Patient Related Outcome Measures launched a Thematic 
Series entitled Veterans and Military Patient-Related Health Outcomes, seeking to 
publish research studies in topics concerning veterans and military health. We invited 
studies that identify and measure clinically relevant outcomes cross-sectionally and 
longitudinally, as well as studies to identify the effectiveness of interventions to improve 
patient-related outcomes in veterans and military service personnel.
In this Thematic Series, Hahn et al reported the development and validation of a 
patient-reported outcome measurement system for caregivers of civilians or service 
members/veterans with traumatic brain injury, investigating the acceptability of a 
computer-based survey administration platform among caregivers. The study discerned 
important considerations for surveying outcomes among caregivers of United States 
service members.1 Also, in the domain of instrument development, Gutierrez et al dis-
cussed the creation and content validity of the Military Concussion Readiness Inventory 
for Dizziness and Balance, which they developed to recognize functional impairments of 
dizziness and balance in service members who experienced a mild blast- or non-blast-
related traumatic brain injury.2 In a study highlighting both the persistence of symptoms 
and the importance of social support, Pereira et al examined family, personality, and 
social support variables as predictors of post-traumatic stress symptoms and quality of 
life in Portuguese veterans who participated in the Colonial War (1961–75).3
We invite researchers to take advantage of data at their institutions and available 
online in patient-related mental and physical health outcomes relevant to military 
deployment and reintegration including, but not limited to, the following examples:
•	 exposure to factors encountered in combat (eg, burn pits, chemical weapons);
•	 opioid safety;
•	 fitness and wellness;
•	 spinal cord and traumatic brain injury;
Correspondence: liana desHarnais 
Castel
Lundy-Fetterman School of Business, 
Campbell University, P O Box 218, Buies 
Creek, NC 27506, USA
Email castel@campbell.edu
Journal name: Patient Related Outcome Measures
Article Designation: Editorial
Year: 2019
Volume: 10
Running head verso: Castel
Running head recto: Castel
DOI: http://dx.doi.org/10.2147/PROM.S204114
 
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Patient Related Outcome Measures 2019:10submit your manuscript | www.dovepress.com
Dovepress 
Dovepress
Patient Related Outcome Measures
Publish your work in this journal
Submit your manuscript here: http://www.dovepress.com/patient-related-outcome-measures-journal
Patient Related Outcome Measures is an international, peer-reviewed, 
open access journal focusing on treatment outcomes specifically 
relevant to patients. All aspects of patient care are addressed within 
the journal and practitioners from all disciplines are invited to submit 
their work as well as healthcare researchers and patient support groups. 
The journal is included in PubMed. The manuscript management system 
is completely online and includes a very quick and fair peer-review 
system. Visit http://www.dovepress.com/testimonials.php to read real 
quotes from published authors. 
Dovepress
82
Castel
•	 quality of care from the serviceperson standpoint, includ-
ing satisfaction ratings and qualitative research on areas 
where veteran care needs improvement.
Please submit your work for consideration for the Veter-
ans and Military Patient-Related Health Outcomes Thematic 
Series.
Disclosure
Professor Castel is the Editor in Chief for Patient Related 
Outcome Measures, an open access journal with Dove Medi-
cal Press. The author reports no other conflicts of interest in 
this work.
References
1. Hahn EA, Ianni PA, Hanks RA, et al. Survey response burden in caregiv-
ers of civilians and service members/veterans with traumatic brain injury. 
Patient Relat Outcome Meas. In press 2019.
2. Gutierrez ML, Christy JB, Whitney SL. Development of military concus-
sion readiness inventory for dizziness and balance. Patient Relat Outcome 
Meas. In press 2019.
3. Pereira MG, Machado JC, Pereira M, Lopes C, Pedras S. Quality of life 
in elderly Portuguese war veterans with post-traumatic stress symptoms. 
Patient Relat Outcome Meas. In press 2019.
Dove Medical Press encourages responsible, free and frank academic debate. The content of the Patient Related Outcome Measures ‘Editorial’ section does not necessarily represent the views 
of Dove Medical Press, its officers, agents, employees, related entities or the Patient Related Outcome Measures editors. While all reasonable steps have been taken to confirm the content of 
each Editorial, Dove Medical Press accepts no liability in respect of the content of any Editorial, nor is it responsible for the content and accuracy of any Editorial.
 
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English

Introducing the first articles of the veterans and military patient-related health outcomes thematic series

https://cufind.campbell.edu/student_pharmaceutical_sciences/1001/thumbnail.jp

Kerkar, Gitanjali

Campbell University
CU FIND
Pharmaceutical Sciences Pharmacy and Health Sciences, College of
2019
Pediatric Milk based Efavirenz Freeze-dried
Nanoemulsion; Formulation and Characterization
Gitanjali Kerkar
Follow this and additional works at: https://cufind.campbell.edu/student_pharmaceutical_sciences
Part of the Pharmacy and Pharmaceutical Sciences Commons
This Book is brought to you for free and open access by the Pharmacy and Health Sciences, College of at CU FIND. It has been accepted for inclusion
in Pharmaceutical Sciences by an authorized administrator of CU FIND. For more information, please contact long@campbell.edu.
Recommended Citation
Kerkar, Gitanjali, "Pediatric Milk based Efavirenz Freeze-dried Nanoemulsion; Formulation and Characterization" (2019).
Pharmaceutical Sciences. 2.
https://cufind.campbell.edu/student_pharmaceutical_sciences/2
.Particle size
Pediatric Milk-based Efavirenz Freeze-dried Nanoemulsion:
Formulation and Characterization
• Approximately 1.8 million children under 15 years of age are living with HIV (c.2017)
• Pediatric patients with HIV have been lagging behind adults in receiving anti-retroviral
therapy (ART) due to numerous barriers, one of which being the lack of appropriate
pediatric anti-retroviral (ARV) drug formulations
• Efavirenz (EFV) is an HIV-1 specific and a first choice anti-retroviral in adults and
pediatric pharmacotherapy
• The available efavirenz formulations for pediatric patients older than 3 months are
Sustiva tablet (600 mg) and capsule (50 mg, 200 mg)
• These formulations are “Pediatric” not necessarily “Pediatric friendly”
• Therefore, there is a need to formulate a product that is easy to administer to pediatric
patients and contains natural and minimum excipients
• The freeze-dried efavirenz o/w nanoemulsion contains milk as the aqueous phase,
medium chain triglyceride as the oil phase and span 80 was added to improve the
homogeneity of the nanoemulsion
• The efavirenz freeze-dried powder will be suitable to administer by dissolving in water
or milk-based drinks or sprinkled on food for oral administration in pediatric patients
three months of age or older.
Introduction
Methods
Drug yield:
Table: 1 Drug content
Batch 1 Batch 2 Batch 3 Average
98.4% 96.7% 105.3% 100.2%
2
3
1
Powder X-Ray Diffraction
Fig 3(a) shows that the drug is crystalline in nature whereas 3(b) shows that the  
freeze-dried formulation is amorphous
10 20 30 40
         0
       500
      1000
      1500
      2000
      2500
2-theta (deg)
Meas. data:Efavirenz/Data 1
In
te
ns
ity
 (c
ps
)
10 20 30 40
         0
       500
      1000
      1500
      2000
      2500
2-theta (deg)
Meas. data:EfavirenzF1/Data 1
In
te
ns
ity
 (c
ps
)
Thermogravimetric Analysis 
The 3 batches of freeze-dried powder showed an average of 1.16% desolvation mass loss 
below 150 °C 
Table: 2 Particle size distribution of EFV freeze-dried reconstituted 
nanoemulsion (d.nm) 
Sample name Z-Ave PDI D(n)10 D(n)50 D(n)90
Batch 1 663.5 0.605 294 381 505
Batch 2 618.6 0.490 281 364 478
Batch 3 526.8 0.562 69.6 89.4 244
Accelerated Stability Study
Table: 3 Accelerated Drug Stability 
Drug yield: 6 days
Batch 1 Batch 2 Batch 3 Average
97.8% 90.8% 94.9% 94.5%
Drug yield: 17 days
89.5% 104.9% 95.6% 96.7%
Particle size (Z-average): 6 days
604.9 561.8 576.1 580.93
Particle size (Z-average): 17 days
597.1 442.6 502.0 513.9
Powder flow studies
Author: Gitanjali Kerkar Research co-advisors: Dr. Qinfeng (Sarah) Liu & Dr. Mali Gupta Research committee: Mr. Paul Johnson 
Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC 27506
• Aqueous phase: non-fat milk + water
• Oil phase: Efavirenz + MCT + span 80
• An oil/water emulsion was formed
Pre-mixing using a 
homogenizer
• The particle size of the emulsion was reduced 
to form a nanoemulsionUltrasonication
• The nanoemulsion was freeze-dried for ~ 40 
hours to form the final formualtionFreeze-drying
Objective
• To formulate a freeze-dried nanoemulsion with particle size less than 1000 nm
• To assess drug yield of the freeze-dried powder
• To determine stability of freeze-dried powder 
• To characterize powder flow property for the freeze-dried formulation
• To characterize crystallinity of the freeze-dried formulation
• To determine the moisture content of the freeze-dried formulation
Results
R² = 0.9995
0
40
80
0 200 400 600 800 1000Ab
so
rb
an
ce
Concentration (mg/mL) 
Fig 1: Calibration curve
Fig 4 (a): Pure efavirenz drug Fig 4 (b): Freeze-dried powder
Fig 3: Thermogravimetric analysis of 3 batches of freeze-dried powder
Fig 2: HPLC analysis of freeze-dried powder Conclusion
Acknowledgement
Hypothesis
A milk based freeze-dried nanoemulsion of efavirenz  with a stable drug content  and a z-
average of less than 1000 nm can be prepared
The angle of repose was determined to understand the
flow of the freeze-dried powder. It was calculated using
the following USP formula:
tan(α)=height/0.5 base
= 62.5 degrees
Fig 5: Angle of repose experiment
• An amorphous final powder formulation was obtained by freeze-drying the nanoemulsion
• Drug yield obtained was within the FDA limit of 90-110%
• The powder could be reconstituted with water to give a nanoemulsion with mean 
hydrodynamic diameter less than 1000 nm
• The freeze-dried powder showed an average of 1.16% mass loss below 150°C 
• There was no significant difference in the drug content from day 0 to day 17; p-value was 
0.4983 > 0.05
• The stability testing results showed that the particle size was less than 1000 nm
• According to the USP <1174>, the powder flow was ‘very poor’
I would like to thank my research co-advisors, Dr. Qinfeng Liu and Dr. Mali Gupta for
giving me this wonderful opportunity and their indispensable guidance. I would also like
to thank my research committee member, Mr. Paul Johnson whose office door was always
open whenever I had a question about my research. I am extremely thankful to Mr. Scott
Staton for his help and advice.
www.pedaids.org
Characterization of freeze-dried formulation
• Drug Content • Thermogravimetric Analysis
• Particle Size Determination • Powder Flow Study
• Powder X-ray Diffraction • Accelerated Stability Study
Drug yield


Pediatric Milk based Efavirenz Freeze-dried Nanoemulsion; Formulation and Characterization

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