196,022 research outputs found
Drug treatment in children with focus on off-label drug use
No full textThere is a lack of paediatric documentation concerning efficacy and safety of many drugs, which contribute to drug use outside the terms of the product license (off-label). In the present thesis, four studies (I-IV), using different settings and design to evaluate pharmacological treatment in children, with focus on off-label drug use, is presented.Outpatient records of purchased prescriptions were retrieved to investigate the frequency and characteristics of paediatric off-label prescribing (I). In Stockholm, 1.8 prescribed drugs per child were purchased in the year 2000. Every fifth drug was classified as an off-label prescription. The proportion of off-label prescriptions was highest for topical drugs, due to lack of paediatric information.A survey of all adverse drug reaction reports to the Medical Products Agency concerning paediatric outpatients in the year 2000 was performed, to investigate the frequency of off-label drug prescribing (II). One hundred and twelve paediatric cases, corresponding to 158 adverse reactions were reported. One third of the reports were regarded as serious, and these were more often associated with off-label drug prescribing. Antiasthmatic drugs were most commonly reported. Psychiatric symptoms were the most commonly reported adverse drug reactions.Paediatric questions and answers to a Drug Information Centre in Stockholm were retrieved and analysed regarding off-label drug use and paediatric literature information adding to the labelling of the drug (III). During a 10-year period, 249 paediatric questions were handled. Every third question concerned off-label treatment, often concerning psychotropic drugs. In every other response to off-label questions, additional paediatric documentation concerning the drug was found in the literature.In a prospective, nation-wide, cross-sectional study, paediatric prescriptions and offlabel drug use to children at hospitals in Sweden were analysed (IV). Enrolment of more than 200 hospital departments resulted in data from 2947 paediatric patients, that received altogether11294 prescriptions within two two-day-periods in 2008. Half of all administered prescriptions concerned either off-label drug use or unlicensed or extemporaneously prepared drugs. Paracetamol was the most common drug used both on- and off-label. Absence of paediatric information was the main reason for the large proportion of off-label prescribing of carbohydrates and electrolytes in hospitals.This thesis has demonstrated substantial off-label prescribing to children in both primary and hospital health care. A common reason for this is the lack of paediatric documentation. Children have the same right as adults to well documented and safe drug therapy. Therefore, it is necessary to improve paediatric documentation through harmonization of existing scientific knowledge and clinical experience, improved structure of SPC information, and more appropriate administration forms. Furthermore, the documentation of drug treatment and its outcomes, including the reporting of adverse drug reactions, need to be improved.List of scientific papersI. Ufer M, Rane A, Karlsson A, Kimland E, Bergman U. (2003). "Widespread off-label prescribing of topical but not systemic drugs for 350,000 paediatric outpatients in Stockholm." Eur J Clin Pharmacol. 58(11): 779-783 https://pubmed.ncbi.nlm.nih.gov/12634986II. Ufer M, Kimland E, Bergman U. (2004). "Adverse drug reactions and off-label prescribing for paediatric outpatients: a one-year survey of spontaneous reports in Sweden." Pharmacoepidemiol Drug Saf 13(3): 147-152 https://pubmed.ncbi.nlm.nih.gov/ 15072113III. Kimland E, Bergman U, Lindemalm S, Böttiger Y (2007). "Drug related problems and off-label drug treatment in children as seen at a drug information centre." Eur J Pediatr 166(6): 527-532 https://pubmed.ncbi.nlm.nih.gov/17195069</p
Off-label drug treatment and related problems in children : a register-based investigation
No full textIntroduction: There is a lack of pediatric documentation concerning efficacy and safety of many drugs, which may contribute to off-label drug treatment and increase the risk for adverse drug reactions (ADRs).Aims: To; (I) analyse the frequency and characteristics of pediatric off-label prescribing; (II) investigate frequency of off-label drug prescribing in pediatric ADR reports; (III) analyse drug related problems, the extent of off-label drug treatment in pediatric questions to a Drug Information Centre (DIC) and pediatric literature information adding to the labelling of the drug in DIC answers.Methods: Three retrospective register based investigations on drug treatment of children less than 16 years of age were performed. In study I, outpatient records of purchased prescriptions were retrieved and analysed. The analysis was restricted to the drugs that account for 90% of the total use (DU90%). In study II, a nation-wide survey of ADR reports to the Medical Products Agency in relation to prescriptions among suspected drugs in outpatients was performed. In study III, questions and answers (Q&A) to a DIC in Stockholm (1995-2004) were characterised and analysed.Results: In Stockholm 1.8 prescribed drugs per pediatric outpatient were purchased in the year 2000. Every fifth drug was classified as an off-label prescription. The proportion of off-label prescription was highest for topical drugs, followed by psychotropic drugs. In the year 2000, 112 pediatric ADR reports corresponding to 158 ADRs in outpatients were reported. The off-label proportion in ADR reports was more than 40%. One third of the reports was regarded as serious and these were more often associated with off-label drug prescribing. Antiasthmatic drugs were most commonly reported. Psychiatric symptoms were the most commonly reported ADRs. During a 10-year period DIC in Stockholm handled 249 pediatric questions and each question addressed on average 1.5 drugs. The questions mainly concerned drugs licensed in Sweden. Adverse drug reactions (ADRs), drug choice or dosing were the most common drug related problems. Every third question was off-label and among these the most common therapeutic group was psychotropic drugs. In every other response to offlabel questions, pediatric documentation concerning drug efficacy and safety was found. The most common reason for a drug to be classified as off-label was lack of pediatric labelling in the Swedish catalogue of medical products.Conclusion: This thesis has demonstrated substantial off-label prescribing in primary health care. Off-label prescribing were common in pediatric ADR reports from primary care. We also found literature information adding to the labelling of the drug. There is a great need for evidence based pediatric drug information, which can be retrieved from a DIC. A future challenge is to further diffuse this knowledge to pediatric prescribers through Internet, expert committees and medical journal databases.List of scientific papersI. Ufer M, Rane A, Karlsson A, Kimland E, Bergman U (2003). Widespread off-label prescribing of topical but not systemic drugs for 350,000 paediatric outpatients in Stockholm. Eur J Clin Pharmacol. 58(11): 779-83. Epub 2003 Feb 22 https://pubmed.ncbi.nlm.nih.gov/12634986II. Ufer M, Kimland E, Bergman U (2004). Adverse drug reactions and off-label prescribing for paediatric outpatients: a one-year survey of spontaneous reports in Sweden. Pharmacoepidemiol Drug Saf. 13(3): 147-52. https://pubmed.ncbi.nlm.nih.gov/15072113III. Kimland E, Bergman U, Lindemalm S, Bottiger Y (2006). Drug related problems and off-label treatment in children at a regional information centre. [Manuscript]</p
Nitrone spin traps and a nitroxide antioxidant inhibit a common pathway of thymocyte apoptosis
No full textOxidative stress has recently been suggested to be a mediator of apoptotic cell death [Buttke and Sandstrom (1994) Immunology Today 15, 7-10], although evidence that this phenomenon is a widespread component of apoptosis is lacking. When rat thymocytes were exposed to the glucocorticoid methylprednisolone (MPS), a progressive increase in intracellular peroxides and a decrease in glutathione (GSH) were observed to accompany the onset of apoptosis. Using Percoll density gradients to isolate subpopulations of thymocytes at different stages of apoptosis, the increase in peroxide content was found to bt restricted to apoptotic cells, while a significant depletion of GSH and reduced protein thiol was detected in both pre-apoptotic and fully apoptotic cells. To investigate the biological significance of these redox changes, the free radical spin traps 5,5-dimethyl-1-pyrroline-1-oxide (DMPO) and 3,3,5, 5-tetramethyl-1-pyrroline-1-oxide (TMPO), and the related nitroxide-radical antioxidant 2,2,6,6-tetramethyl-1-piperidinyl-1-oxyl (TEMPO) were tested as inhibitors of thymocyte apoptosis. The cell shrinkage and DNA fragmentation induced by four different initiators of apoptosis were reduced by each compound. TEMPO inhibition of both etoposide- and MPS-induced thymocyte DNA fragmentation was also found to correlate with an increase in intracellular GSH, providing support for the proposal that its antioxidant properties were responsible for the observed protective activity. We conclude that some form of intracellular oxidation (here measured indirectly by changes in intracellular GSH and peroxide levels) is required during thymocyte apoptosis even when this process is initiated by an agent that does not exert a direct oxidant action
SULFUR-DIOXIDE AND SODIUM METABISULFITE INDUCE BRONCHOCONSTRICTION IN THE ISOLATED-PERFUSED AND VENTILATED GUINEA-PIG LUNG VIA STIMULATION OF CAPSAICIN-SENSITIVE SENSORY NERVES
No full textIn this study the relationship between sulfur dioxide-induced sensory nerve activation and acute bronchoconstriction was assessed. We also studied the effects of sodium metabisulfite, an agent that is suggested to increase airway resistance via activation of sensory nerves. Sulfur dioxide (250 ppm) induced a characteristic biphasic bronchoconstriction. Concomitantly sulfur dioxide induced the release of calcitonin gene-related peptide (CGRP) from capsaicin-sensitive sensory nerves into the pulmonary circulation. In lungs of guinea pi,os pretreated with a neurotoxic dose of capsaicin, the first phase of bronchoconstriction was reduced and the overflow of CGRP was not detectable. Tetrodotoxin abolished the initial phase of the bronchoconstriction induced by sulfur dioxide, indicating that a local neural reflex depending on sodium channels was operant. Inhibition of the vanilloid receptor with capsazepine slightly, although not significantly, reduced the contractile responses to sulfur dioxide. Sodium metabisulfite, when infused via the pulmonary circulation (3 mM), induced bronchoconstriction which was abolished by capsaicin pretreatment, but not significantly reduced by capsazepine. The results indicate that in the isolated guinea pig lung inhaled sulfur dioxide induces initial bronchoconstriction in part via sensory nerve activation, while other mechanisms are involved in the late effect. Sensory nerve activation appears to be the only mechanism for bronchoconstriction induced by infused sodium metabisulfite. A role for sensory nerve-mediated bronchoconstriction by sulfur dioxide or sodium metabisulfite via activation of the vanilloid receptor could not be conclusively demonstrated by this study using capsazepine
Dr. Duane M. Jackson, Morehouse College, July 2011
No full textThis video is a conversation with Dr. Duane M. Jackson. Dr. Jackson talks about his paper, "Recall and the Serial Position Effect: The Role of Primacy and Recency on Accounting Students' Performance." Jackie Daniel, AUC Woodruff Library, is the interviewer
"Reflections on the subject of Emigration from Europe with a view to Settlement in the United States" By M. Carey.
No full text"Reflections on the subject of Emigration from Europe with a view to Settlement in the United States: containing bried sketches of the moral and political character of those states.
By M. Carey, member of the American philosophical, and of the American Antiquarian Society, and author of The Olive Branch, Cindiciae Hibernicae, essays on banking, on political economy, and on internal improvement.
To which are now added the English editor's comments on the subject; together with Important Advice to Emigrants, and Cautions Against Impositions Practiced in the Outports
Dispelling the Myths Behind First-author Citation Counts
No full textWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Dr. Glendon Swarthout
No full textHosted by Roger M. Busfield, MSU Assistant Professor of Speech and Theater, Meet the Author is designed to introduce a general audience to a contemporary author and their work through in-depth interviews. This episode features a conversation between Dr. Glendon Swarthout, prolific author and English professor at MSU, and assistant professors Sam S. Baskett and Theodore B. Strandness
Simulation of thermal plant optimization and hydraulic aspects of thermal distribution loops for large campuses
No full textFollowing an introduction, the author describes Texas A&M University and its utilities system. After that, the author presents how to construct simulation models for chilled water and heating hot water distribution systems. The simulation model was used in a $2.3 million Ross Street chilled water pipe replacement project at Texas A&M University. A second project conducted at the University of Texas at San Antonio was used as an example to demonstrate how to identify and design an optimal distribution system by using a simulation model. The author found that the minor losses of these closed loop thermal distribution systems are significantly higher than potable water distribution systems. In the second part of the report, the author presents the latest development of software called the Plant Optimization Program, which can simulate cogeneration plant operation, estimate its operation cost and provide optimized operation suggestions. The author also developed detailed simulation models for a gas turbine and heat recovery steam generator and identified significant potential savings. Finally, the author also used a steam turbine as an example to present a multi-regression method on constructing simulation models by using basic statistics and optimization algorithms. This report presents a survey of the author??s working experience at the Energy Systems Laboratory (ESL) at Texas A&M University during the period of January 2002 through March 2004. The purpose of the above work was to allow the author to become familiar with the practice of engineering. The result is that the author knows how to complete a project from start to finish and understands how both technical and nontechnical aspects of a project need to be considered in order to ensure a quality deliverable and bring a project to successful completion. This report concludes that the objectives of the internship were successfully accomplished and that the requirements for the degree of Degree of Engineering have been satisfied
Intern experience at CH���M Hill, Inc.: an internship report
No full textIncludes author's vita"Submitted to the College of Engineering of Texas A&M University in partial
fulfillment of the requirement for the degree of Doctor of Engineering."Includes bibliographical referencesA review of the author's internship experience with CH���M HILL, Inc.
during the period September 1975 through May 1976 is presented. During this nine month
internship the author worked as an Engineer II in the Industrial Processes discipline of this
large consulting engineering firm... The author's prime responsibility was as one of three
lead design engineers on the design of a large wastewater treatment facility for a pulp mill
in Hoquiam, Washington owned by ITT Rayonier Inc. The work generally consisted of the design
of individual treatment units and associated piping and pumping. The purpose of the project
was to provide wastewater treatment capabilities that would satisfy the effluent limitations
(standards) imposed upon the mill by the State of Washington Department of Ecology and the
U.S. Environmental Protection Agency. The author's assignment also entailed necessary
interaction with the project manager and other CH���M HILL design engineers and support staff
members, the client's representatives, and representatives of two other consulting engineering
firms working on the project. Thus, the internship position at CH���M HILL provided considerable
experience coordinating the author's work with the work of other engineers, guiding the design
and administrative efforts of a support staff, and interacting regularly with the client and
other consulting firms. This broad exposure to a variety of engineering and organizational
problems provided a valuable educational experience
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