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This report describes a librarian's development of an interactive and competitive trivia game using Poll Everywhere, an audience response system software. The trivia game was implemented during a live lecture session on drug information mobile applications taught to first-year pharmacy students. To add a fun and engaging reference for students, the librarian decided to model the game after HQ, a free trivia gaming app. Development of the session, student response, changes to future iterations, and lessons learned by the librarian are described.

Background Sedentary behaviors are associated with numerous adverse physiological health outcomes, morbidity and mortality, although with limited knowledge in young adults. Aim To assess the association between sedentary behavior, muscular strength and body composition in male and female young adult college students. Methods A cross-sectional pilot study was conducted among 94 college students (20.2 ± 1.6 years, 46 males and 48 females) from a University in the Mid-Atlantic region, US. Students were assessed for sedentary behavior, physical activity and objective physiological variables including lean body mass (LBM), fat% and muscular strength [1-Repetition Maximum (1-RM)]. Descriptive statistics and linear regression analysis were conducted. Results Sedentary behavior (sitting time ≥ 6 h/day) was prevalent in 69% of females and in 46% of males, p = .036, although most students (84–94%) met the physical activity recommendations. Sitting time inversely correlated with LBM (r = −0.58, p = .01) and trending for positive correlation with fat% in females, whereas in males, sitting time inversely correlated with 1-RM upper body strength (r = −0.46, p = .017). Female students who sat ≥7.5 h/day had approximately 10-fold increased chance of being obese [odds ratio = 9.6, 95% confidence interval (1.5 to 62.7), p = .019] compared to non-sedentary. Conclusions Although most students were physically active, considerable prevalence of sedentary behavior was observed. The novel findings showed that, sedentary behavior was associated with compromised physiological health determinants of body composition in females and muscular strength in males. Reducing sedentary behavior among active college students could be a public health strategy for health promotion and chronic disease prevention.

Purpose The accuracy of cost savings and reimbursement predictions for medications added to an academic medical center formulary was assessed. Methods Formulary changes over a 5-year period were reviewed by the investigators. Medications were included if the medication was added to formulary and the monograph included cost savings or reimbursement data that indicated a positive net margin. The primary endpoints were percent predicted cost savings and net margin per medication based on medication cost only. Secondary endpoints included the percent of medications with at least 100% predicted cost savings or net margin and evaluation of median percent predicted savings or net margin individually. Results The pharmacy and therapeutics committee reviewed 558 formulary agenda items, 184 of which were selected for further analysis. In total, 19 medications were identified as having a predicted monetary advantage. The endpoints of percent predicted cost savings and net margin yielded a median of 76.5% (range 72.9-188.71%) (n = 3) and 148.2% (IQR 108.9-543.3%) (n = 16), respectively. For 13 (68%) of 19 medications, the percent predicted cost savings or net margin was at least 100%. Conclusion Economic predictions utilized for formulary management at an academic medical center generated net positive monetary value for medications where predicted cost savings or reimbursement factored into the decision to add a medication to the formulary.

Background and objectives The Cochrane Central Register of Controlled Trials (CENTRAL) is compiled from a number of sources, including PubMed and Embase. Since 2017, we have increased the number of sources feeding into CENTRAL and improved the efficiency of our processes through the use of application programming interfaces, machine learning, and crowdsourcing.Our objectives were twofold: (1) Assess the effectiveness of Cochrane's centralized search and screening processes to correctly identify references to published reports which are eligible for inclusion in Cochrane systematic reviews of randomized controlled trials (RCTs). (2) Identify opportunities to improve the performance of Cochrane's centralized search and screening processes to identify references to eligible trials. Methods We identified all references to RCTs (either published journal articles or trial registration records) with a publication or registration date between 1st January 2017 and 31st December 2018 that had been included in a Cochrane intervention review. We then viewed an audit trail for each included reference to determine if it had been identified by our centralized search process and subsequently added to CENTRAL. Results We identified 650 references to included studies with a publication year of 2017 or 2018. Of those, 634 (97.5%) had been captured by Cochrane's Centralised Search Service. Sixteen references had been missed by the Cochrane's Centralised Search Service: six had PubMed-not-MEDLINE status, four were missed by the centralized Embase search, three had been misclassified by Cochrane Crowd, one was from a journal not indexed in MEDLINE or Embase, one had only been added to Embase in 2019, and one reference had been rejected by the automated RCT machine learning classifier. Of the sixteen missed references, eight were the main or only publication to the trial in the review in which it had been included. Conclusion This analysis has shown that Cochrane's centralized search and screening processes are highly sensitive. It has also helped us to understand better why some references to eligible RCTs have been missed. The CSS is playing a critical role in helping to populate CENTRAL and is moving us toward making CENTRAL a comprehensive repository of RCTs.

Background and purpose Hospital pharmacists routinely receive and answer drug information questions via telephone while performing order verification. This report describes the development, implementation, and evaluation of a mock learning experience for student performance of these tasks in a health-systems pharmacy laboratory course. Educational activity and setting An active learning skills-based exercise involving students receiving and answering a standardized drug information question via telephone during an order verification activity, referred to as a cold-call exercise, was developed and implemented. Data collected included student grades on a baseline assessment, the cold call exercise, order verification exercises, and student perceptions from a voluntary post-exercise survey. Student performance on the cold-call exercise was further evaluated via individual sections of the cold-call rubric. Data were summarized using descriptive statistics. Thematic analysis of student opinion and an estimate of faculty time were also executed. Findings Student grades on the cold call and order verification exercises were 86.14% and 88.8%, respectively. Students often failed to ask category-specific questions because they did not categorize the ultimate question appropriately. Students found the activity organized and applicable. Time dedicated to creation was extensive, but execution and grading were reasonable. Summary Students performed well on the drug information exercise as well as the order verification component. Students and faculty enjoyed the experience, and students found the exercise relevant and challenging. This exercise could be implemented into any pharmacy curriculum in order to prepare students using authentic learning experiences.

This study assessed the efficacy of an interactive Moodle lesson teaching the subject of references commonly used to answer drug information (DI) questions on pharmacy student performance and retention. Students were randomized to receive education via either the lesson or a recorded lecture. Students completed a baseline knowledge assessment, an assignment following instruction, the same baseline assessment at the end of the semester to assess retention, and a survey on their experience with the assigned education technique. The differences of median grades on assessments and survey results between groups were compared via Mann-Whitney U tests. Student performance on the baseline assessment was comparable between groups (n = 40 per group; 47.22% vs. 48.61%). Retention of knowledge was less in students in the lesson group (63.89%) than in the lecture group (75%). Students taught by lecture performed better (90.63%) than those taught by lesson (87.5%) on the post-instruction assignment. Survey results from participants (n = 32/80) showed more students in the lecture group (n = 16) agreed time associated with educational technique was reasonable (69% vs. 31%), technique was valuable to learning (75% vs. 44%), and experience was satisfying (56% vs. 31%). These results show student retention of knowledge was not improved with use of a Moodle lesson in comparison with a recorded lecture. Student performance was better immediately following education when taught by lecture and more lecture-taught students agreed the educational technique was time-appropriate, valuable, and satisfying.

The ability to evaluate clinical literature is a key skill for pharmacy students and pharmacists to develop. This chapter provides considerations when reading an article to help readers develop this ability. The structure of this chapter mimics that of a standard article in addition to highlighting many other considerations as it relates to clinical literature publishing and evaluation.

Objective Recent studies suggesting clinical superiority of linezolid over vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia led to a change in our institution's clinical pathway/order form for hospital-acquired pneumonia, positioning linezolid as the preferred agent. Our objective was to assess the impact of this change within our institution. Design Retrospective electronic medical records review. Methods The analysis for this observational study included eligible patients admitted to our medical center between May 1, 2011, and August 31, 2014, with ICD-9 codes for MRSA and pneumonia. Included patients were at least 18 years of age and had vancomycin or linezolid initiated at least 2 days after admission and continued for at least 2 consecutive days. The primary end points were extent of antibiotic use before and after order form change and length of stay (LOS) and hospital charges in the two treatment groups. A secondary aim was to detect any gross discrepancies in patient outcomes such as treatment duration, mechanical ventilation duration, all-cause mortality rate, nephrotoxicity, and 30-day readmission between the two treatment groups. Measurements and Main Results Outcomes in 227 patients were assessed. Linezolid use increased 16.2% subsequent to the change in the order form. Although not statistically significant, the median hospital admission charge was $6200 lower in patients treated with linezolid compared with those treated with vancomycin ($25,900 vs $32,100). Hospital LOS was significantly associated with Charlson Comorbidity Index score (p

Purpose The collaboration between a drug information center (DIC) and an academic detailing program is described. Methods An agreement was reached between the South Carolina Offering Prescribing Excellence (SCORxE) academic detailing program and the Medical University of South Carolina (MUSC) Drug Information Center (DIC) to provide responses to drug information (DI) questions pharmacists received on academic detailing visits. Questions received were analyzed to determine the impact that the collaboration had on MUSC DIC requests. Results From May 2009 to October 2012, the MUSC DIC answered 2727 DI questions, 62 (2.3%) of which were generated by SCORxE. Compared with DIC questions received from other sources, academic detailing questions were more likely to be therapeutic consultations, reference searches, or dosage queries and less likely to be about formulation or drug interactions. When comparing the deadline for the 62 academic detailing requests with the deadline for all other requests, the academic detailing requests allowed for a longer median time to deadline per request (21.2 days versus 27.1 hours). The majority of SCORxE questions (68%) were completed by students or residents. Benefits of the collaboration for the DIC included advanced educational opportunities for learners, increased dissemination of provided information, external funding, and scholarship opportunities. SCORxE has benefited from increased access to information and efficiency. Conclusion Collaboration between an academic detailing program and an academic medical center DIC has proven beneficial for both parties. Questions have been communicated by a simple and effective process and have required more research than queries received from other sources.

Objective: A retrospective study was conducted to assess the diagnosis and treatment of urinary tract infections (UTIs) using urinalyses (UA)s at a psychiatric hospital. Method: Patients admitted between July 2010 and June 2011 receiving at least one UA during inpatient psychiatric hospitalization were included. Pregnant patients and those with a UA receiving antibiotic treatment in the emergency department were excluded. The primary objective of the study was to characterize and assess the appropriateness of UAs ordered for the diagnosis of UTIs. Secondary objectives included analyzing frequency of cultures obtained, appropriateness of empiric antibiotics, and de-escalation of therapy if warranted. Results: Thirty-nine percent ( n = 891/2292) of patients admitted received a UA at least once during their hospitalization. Of 203 patients further evaluated, 78% were asymptomatic, 11% were older than 65 years of age with altered mental status (AMS) or dementia, and 11% had typical UTI symptoms. Thirty-one patients were given antibiotics for a UTI during their stay, with a majority of those being asymptomatic ( n = 19/31). Conclusions: A significant proportion of UAs ordered at a psychiatric hospital were inappropriate. When patients were treated, empiric antibiotic selection and length of treatment were appropriate in most instances.

The purpose of this investigation was to describe the just noticeable difference (JND) in perceived exertion during cycle exercise. Males (n = 20) and females (n = 26) (21.4 ± 3.1 year) performed load-incremented cycle exercise to peak intensity. At the end of each minute, subjects rated their overall-body perceived exertion using the OMNI (0-10) rating of perceived exertion (RPE) scale. Individual regression derived the power output (PO) corresponding to RPE 5. This PO served as the standard stimulus (SS). On a separate occasion, four 5-min cycling bouts were performed with 5 min rest between bouts. During bouts 1 and 3 subjects cycled at the SS. During bouts 2 and 4 subjects adjusted the resistance to achieve a level of exertion just noticeably above/below the SS. The difference in final 30-s oxygen consumption (VO2) and PO between each JND bout and the previous SS were the above (JND-A) and below (JND-B) perceived exertion JNDs. JND-A and JND-B were compared between genders and between subjects exhibiting lower versus higher ventilatory threshold (VT) and VO(2PEAK) within genders for VO2 (l · min(-1), %VO(2PEAK)) and PO (W, %SS). JND-B was significantly (P0.05) greater than JND-A for VO2 and PO, when expressed in absolute (l · min(-1), W) and relative units (%VO(2PEAK), %SS). Males exhibited greater JND values than females in absolute, but not relative, units. Subjects with lower and higher VT and VO(2)PEAK exhibited similar JND values. The JND can serve as an effective tool to measure perceptual acuity and to determine individual ability to self-regulate prescribed exercise intensities.

OBJECTIVE: To determine the optimal approach for transitioning therapy to aripiprazole from other antipsychotics in schizophrenia and to describe these strategies. DATA SOURCES: MEDLINE (January 2000-March 2012) and PubMed (January 2000-March 2012) searches were conducted using the search terms aripiprazole, switch, and switching. Citations from references were reviewed to identify additional primary literature. STUDY SELECTION AND DATA EXTRACTION: Articles identified as primary literature were considered for inclusion. Case series, opinion papers, and review articles were also examined. Literature was required to be in English. For evaluation purposes, included articles were randomized trials specifically comparing different switching strategies from an alternative antipsychotic to aripiprazole. Randomized trials and single-arm studies that evaluated the effect of a change to aripiprazole and reported switching methods were also reviewed but not evaluated. DATA SYNTHESIS: Aripiprazole, an atypical antipsychotic agent with a unique mechanism of action, causes fewer adverse effects when compared with other atypical antipsychotics. Patients unable to tolerate or unresponsive to their current regimens might benefit from a change to aripiprazole, but the best method for switching is unknown. Four randomized trials were identified that compared the efficacy, safety, and tolerability of at least 2 different switching strategies. The 5 strategies used a combination of immediate or titrated initiation of aripiprazole with immediate or tapered discontinuation of the current antipsychotic. A significant worsening of symptoms in the abrupt discontinuation group when compared with the combined tapered discontinuation groups was seen in 1 trial at week 2; however, all other comparisons yielded no significant differences among switching strategies. CONCLUSIONS: Strategies for transitioning therapy to aripiprazole from alternative antipsychotics in schizophrenia have been investigated in randomized trials, but studies have failed to establish a preferred method. Despite the lack of evidence, experts recommend an overlap strategy that includes maintaining the current antipsychotic dosage while titrating to a therapeutic dose of aripiprazole.

Summary Objective Surgical treatment of drug-resistant epilepsy is the last resort to reduce or completely cure epilepsy. The objectives of this study were firstly, to study the different profiles and postoperative complications for patients managed at our institution and also to estimate the cost of explorative study by stereoelectroencephalographic electrodes (SEEG). Method A retrospective study was conducted on patients operated between 2003 and 2008 and followed by the Neurology Department. Results A total of 104 medical records were analyzed. The average patient age at surgery was 34 years (range 10–70 years) and mean duration of epilepsy before surgery 21 years (range: 3–56 years). In 80% of cases, type temporal epilepsy was encountered, mainly treated by temporal resection (72%). One year after surgery, 60% of patients were seizure-free(Engel class I), 62% of the patients could resume their work or school and 26% of patients had permanent postoperative complications, minor and expected in the majority of them; no deaths have been reported. Discussion/conclusion Two types of medical devices are used in the management of epilepsy surgery: the left vagus nerve stimulation (8900 € paid besides hospital benefits) and the electrodes of stereo-electroencephalography (SEEG) in possible prior to conventional surgery. Having introduced the use of SEEG electrodes in our institution in 2004, for epilepsy surgery an average of 11 electrodes (eight to 15 electrodes) is required at an average cost of € 4284 per patient. These electrodes represent 58% of average tariff, of the disease-related groups found among patients (€ 7418). In our study, epilepsy surgery appears to be of significant clinical benefit. However, the cost-effectiveness of conventional surgery for epilepsy post-SEEG must be reevaluated to confirm the long-term interest.

Objective: To describe a method for creating an electronic document management (EDM) system at a drug information (DI) center based at an academic medical center to improve efficiency and provide increased availability through remote access. Summary: At DI centers, written materials not available electronically are often stored in file cabinets and retrieved by an individual when required. This process can be time-consuming and inefficient. Various EDM programs were evaluated and compared based on capabilities, cost of implementation and maintenance, and efficiency. Following program selection, documents were scanned onto a dedicated personal computer (PC) and organized according to a predetermined hierarchy of folders. Specialists then performed optical character recognition (OCR) and entered authors, titles, and assigned key words for each new electronic file. Results: It was determined that Adobe Acrobat software fulfilled all requirements at minimal expense. A specialist is able to scan and electronically file 72 documents (496 pages) per hour, perform OCR on 40 documents per hour, and attach titles, authors, and key words to newly scanned documents at a rate of 10 articles per hour. This EDM system is capable of storing in excess of 70,000 documents on a PC with 250 GB of hard disk space and 4 GB of random access memory, which can be accessed remotely from any computer through a secure virtual private network connection. Conclusions: Adobe Acrobat software, when combined with a high-resolution scanner, provides an inexpensive method for EDM that allows for immediate document retrieval, expansion of operations, and remote access.

Resume Objectif Le traitement chirurgical de l’epilepsie pharmacoresistante constitue le dernier recours vers la reduction, voire la guerison totale de l’epilepsie. Les objectifs de ce travail etaient, d’une part, d’etudier les differents profils et les complications postoperatoires des patients pris en charge dans notre etablissement et d’autre part d’estimer le cout des explorations par les electrodes de stereo-electroencephalographie (SEEG). Methode Une etude retrospective a ete menee sur les patients operes entre 2003 et 2008 et suivis par le service de neurologie. Resultats Au total, 104 dossiers medicaux ont ete analyses. La moyenne d’âge des patients lors de l’intervention etait de 34 ans (extremes : 10–70 ans) et la duree moyenne de l’epilepsie avant l’operation de 21 ans (extremes : 3–56 ans). Dans 80 % des cas, l’epilepsie rencontree etait de type temporal, principalement traitee par une resection temporale (72 %). Un an apres la chirurgie, 60 % des patients etaient libres de crises (classe I d’Engel), 62 % des patients ont pu reprendre leur activite professionnelle ou scolaire et 26 % des patients avaient des complications postoperatoires permanentes, mineures et attendues chez la majorite d’entre eux ; aucun deces n’a ete rapporte. Discussion/Conclusion Deux types de dispositifs medicaux existent pour la prise en charge de la chirurgie de l’epilepsie : la stimulation du nerf vague gauche (8900 € pris en charge en sus des prestations d’hospitalisation) et les electrodes de SEEG en prealable possible a la chirurgie conventionnelle. Ayant debutee dans notre etablissement en 2004, l’utilisation des electrodes de SEEG pour la chirurgie de l’epilepsie necessite en moyenne 11 electrodes (de 8–15 electrodes) pour un cout moyen de 4284 € par patient. Ces electrodes representent 58 % du tarif moyen des groupes homogenes de sejours (GHS) retrouves chez les patients (7418 €). Selon notre etude, la chirurgie de l’epilepsie semble presenter un benefice clinique important. Neanmoins, le rapport cout–efficacite de la chirurgie conventionnelle de l’epilepsie post-SEEG doit etre reevalue a long terme pour en confirmer l’interet.

The objective of the study was to conduct a retrospective audit of patients who presented with priapism in Western Australia during the years 1985-2000. We searched the records of the teaching hospitals in metropolitan Perth and those of the Keogh Institute for Medical Research for the diagnostic code for priapism. A total of 82 episodes of priapism in 63 patients occurred over this 16 year period. In all, 62 episodes occurred after intracavernosal injections (ICI) and 20 were due to other causes. Treatment of priapism included simple aspiration of blood, intracavernosal injection of alpha-adrenergic agents and surgical shunt procedures. Priapism occurring outside the setting of ICI was more likely to require surgery; seven of 20 episodes. After ICI therapy, eight of 62 episodes required shunts. The use of prostaglandin E1 as the drug of choice in ICI therapy in 1989 led to a fall in the incidence of ICI-induced priapism. Priapism is a major side effect of ICI therapy and an uncommon, although important, side effect of other conditions. The incidence of priapism has fallen with the introduction of prostaglandin E1 monotherapy as the favoured drug for ICI therapy of erectile failure.

Wyeth-Ayerst has discontinued production of Antivenin (Micrurus fulvius). Currently, there is no other approved coral snake antivenom available in the United States.This study was a randomized, placebo-controlled and blinded determination of the ability of a Mexican Micrurus (coral snake) antivenom and an Australian Notechis (tiger snake) antivenom to prevent lethality from a United States Micrurus fulvius fulvius venom in a mouse model. Venom dosing was based on an LD50 determined for this experiment. Our comparison groups included: (1) M. f. fulvius venom + Micrurus antivenom, (2) M. f. fulvius venom + Notechis antivenom, (3) M. f. fulvius venom + protein control, (4) 0.9% normal saline + protein control, (5) saline + Notechis antivenom, (6) saline + Micrurus antivenom. Venom dose was 5 times the determined LD50. The antivenom amounts were capable of neutralizing 10 times the venom injected (50 times the LD50).The LD50 of M. f. fulvius venom was determined to be 0.85 mg/kg. All mice in both antivenom test groups were protected from lethality for the entire 24-hour observation period. Six of the 7 mice in the venom test group died, with a survival time of 349 +/- 382 minutes (mean +/- s.d.) after the venom injection. All three groups of control mice survived the entire 24-hour observation period.Mexican Micrurus antivenom and Australian Notechis antivenom provide protection from lethality in mice envenomated with a United States M. f. filvius venom.

Objective To review the pharmacology, pharmacokinetics, efficacy, and safety of rufinamide in the treatment of epileptic seizures and describe its potential place in therapy. Data sources MEDLINE (1966–January 2010) and PubMed (1966–January 2010) literature searches were conducted to identify primary literature investigating rufinamide. References from selected publications discussing rufinamide, as well as the package insert, were reviewed. Study selection and data extraction Published controlled trials describing the efficacy and safety of rufinamide were given preference. Available abstracts were also reviewed. Four published trials were identified and included and a retrospective review of the clinical use of rufinamide was also analyzed. The remainder of the information described is from 4 abstracts. Data synthesis Rufinamide is a new antiepileptic agent that differs structurally from other antiepileptic drugs and is approved as adjunctive therapy for Lennox-Gastaut syndrome (LGS). It presumably provides its antiseizure activity by prolonging sodium channel inactivity, stabilizing cell membranes. It is absorbed and metabolized extensively, then excreted renally as an inactive metabolite. Clinical trials show that adjunctive rufinamide is effective at reducing seizure frequency in patients with LGS and refractory partial seizures. Rufinamide showed no effect on cognitive function in patients with refractory partial seizures. Short-term adverse event rates were similar to those of placebo. Safety data from long-term studies show that rufinamide is well tolerated, causing headache, dizziness, and fatigue at rates of >10%. Rufinamide has few clinically relevant drug interactions, although it does increase phenytoin serum concentrations, while valproate increases rufinamide serum concentrations. Conclusions Data show that rufinamide is safe and effective as an adjunctive agent for LGS and may be used to treat partial seizures. The benefits of rufinamide include its pharmacokinetics, limited drug interactions, and lack of effect on cognitive function, but its use is limited by the rarity of LGS and the lack of comparative data with other antiepileptic agents.

Purpose. Current and alternative approaches to documenting drug information (DI) questions at DI centers in the United States and features of a software program used for documenting poison information are described. Methods. A survey was distributed through an Internet listserver for DI specialists in institutional or academic practices. The survey requested information regarding the use of electronic databases to document DI inquiries and the type of databases used. Documented DI questions during a nine-month period using Visual Dotlab (Visual Dotlab Enterprises, Fresno, CA) at the University of Pittsburgh Medical Center (UPMC) DI center were analyzed to demonstrate the feasibility and efficiency of the software for documenting DI questions. Results. Thirty-three DI centers responded to the survey, and 22 (67%) used electronic databases for question documentation. Of these, 15 (68%) were created with Microsoft Office Access (Microsoft Corporation, Redmond, WA). At the UPMC DI center, 841 DI questions were documented using Visual Dotlab. Questions from pharmacists, nurses, and physicians accounted for 654 (78%) of entries. Drug–drug interactions (12%) and dosage recommendations (12%) were the most common types of questions received. On average, DI specialists spent 46 minutes per response, which required an average of 1.7 follow-up calls per inquiry. Quality assurance was performed on 98% of questions documented. Conclusion. Visual Dotlab is not well-known and is currently not used widely by DI centers. However, it includes features that may help DI centers document and retrieve DI questions efficiently and comprehensively.

To explore the possibility of using venous sclerosant therapy to overcome venogenic impotence we studied the effects of ethanolamine on the veins draining the dog penis. Following injection of the sclerosant into the deep dorsal vein radiological and histological evidence of occlusion was obtained but by one month recanalization of thrombi had occurred and collateral venous channels had formed. These findings cast doubt on the effectiveness of this sclerosant as a means of treating impotence. (J. Urol, 144: 381-384, 1990)

Modern automotive applications, such as X-by-Wire, are implemented over distributed architectures that include several electronic control units (ECUs) communicating via one or more communication protocols, such as CAN (Controller Area Network) and TTP (Time-Triggered Protocol), over network broadcast buses. In these scenarios of increasing complexity, it is paramount for the designer to try different implementations quickly in terms of software distribution and communication protocols, so as to satisfy the requirements of cost, real time and safety. In this paper, we present a novel way of rapidly prototyping communication protocols that are typical of the automotive domain. An implementation of the key enabler of the rapid prototyping framework, the Universal Communication Model (UCM), is described.

Australian Natural History Series: Great Whales. John Bannister. 2008. CSIRO Publishing, Collingwood, Victoria, Australia. 142 pp. $27.45. ISBN: 978-0-64309-373-7 (softcover). Australian Natural History Series: Platypus. Fourth Edition. Tom Grant, illustrated by Dominic Fanning. 2008. CSIRO Publishing, Collingwood, Victoria, Australia. 159 pp. $27.45. ISBN: 978-0-64309-370-6 (softcover).

Primary bladder stones are described as occurring in aboriginal children from native reserves. Here breast feeding is supplemented early in life with white flour and little else. A comparison is made between this diet and that of children in endemic bladder stone regions, and reasons are advanced for the formation of these stones, with biochemical evidence to support the thesis that ammonium acid urate precipitation is the initiating factor.

The efficacy of papaverine and phenoxybenzamine as a pharmacological treatment of impotence was compared in a double blind, crossover, placebo controlled trial. Thirty-four impotent men received intra-cavernosal injections of papaverine (60 mg), phenoxybenzamine (6 mg) or normal saline (10 ml) at monthly intervals. Observations by EJK up to 45 minutes after injection demonstrated that papaverine caused full erections in 35% of men and partial erections in 62%. Phenoxybenzamine injection resulted in full erections in 20% of men and 62% had partial erections. The differences were not significant. Despite 82-97% of patients attaining some degree of erection in the clinical setting only six of the patients decided to use this mode of treatment for more than three months. Sexual function during the month after injection was better with either drug when compared with placebo.

Tumor immunity in 31 colonic tumor patients was studied by determining in vitro leukocyte-migration inhibition. In tissue culture 30 per cent inhibition of patient leukocyte migration by tumor antigen could be demonstrated in half of the patients, suggesting that they were immune. This immunity was not related to the clinical or pathologic stage of the disease and varied in different patients. It was transient in some and persistent in others. In addition, a positive response at a fixed time after operation was not found.

This document provides an examination of various aspects of the Occupational Safety and Health Administration (OSHA)Carcinogen Policy. To satisfy the dimensions of the Policy's broad, general nature, a two-fold approach was taken. Throughout, the focus is on the possible effects of the Policy's implementation, but this is first approached as it generally will effect research and compliance activities across broad industry sectors, while specific impacts on DOE are addressed separately. To overview and integrate these approaches, and to provide a quick reference for further information, an outline of information is presented. General or industry-wide applications are addressed both in the Summary and Overview of the Policy (Chapters I and II) and in the discussion of the Model Standard (Chapter V). Also included is a copy of the Policy itself in the General Industry Standards and interpretations Change 10. Sections specifically addressed to the major concerns of DOE and its contractors are a discussion of implications for action regarding the synthetic fuels program, a comparison of the OSHA Model Regulations and the FE OSH Manual Standards for Carcinogens, and finally, a list of known carcinogens in coal gasification/liquefaction. Together, these elements illustrate the broad scope of the policy's impact, which economicmore » and other constraining consequences begin to become visible. Measures to minimize these consequences are a common underlying theme to each of the sections.« less

Bladder stone is a relatively common disease of childhood in West Sumatra with an incidence of 8.3/100,000 population per year. We have studied 87 cases with a peak age of onset of 2-4 years and a male/female ratio of 12:1. The majority of these are from poor families with a diet low in protein and phosphate. Diarrhoea is common. The composition of the stones is primarily ammonium acid urate. Patients with sterile urine have shown significantly higher levels of urinary ammonia than controls, and only approximately 50% of patients' urine were infected. This is consistent with excretion of a high acid load, due both to an acidogenic rice diet and diarrhoea, combined with a low level of phosphate. This condition was once endemic in Europe but is now confined to a belt of countries from the Balkans through Asia.

Summary— We describe the management of 17 men who developed prolonged erections following the intracorporeal injection of vasoactive drugs (e.g. papaverine) for the treatment of erectile dysfunction. Twelve men who had psychogenic impotence developed prolonged erections following injection compared with 5 who had an organic aetiology. The aspiration of 20 to 50 ml of blood from the penis together with the intracorporeal injection of 1 to 2 mg metaraminol is an effective treatment of this complication.

The complications associated with a variety of penile prostheses used in the treatment of 302 men with erectile dysfunction are described. Infection of the prostheses resulted in their removal from 11 patients (3.6%), antibiotic therapy and replacement in five men. Mechanical failures required reoperation in 43 men (14.2%); however, recent advances in prosthesis design have reduced this type of malfunction. Adverse psychological reactions prompted removal of the prostheses from two men. Despite these complications, this surgery is remarkably effective.