Application of basic pharmacology and dispensing practice of antibiotics in accredited drug-dispensing outlets in Tanzania

PubMed Central

Minzi, OM; Manyilizu, VS

2013-01-01

Background Provision of pharmaceutical services in accredited drug-dispensing outlets (ADDOs) in Tanzania has not been reported. This study compared the antibiotics dispensing practice between ADDOs and part II shops, or duka la dawa baridi (DLDBs), in Tanzania. Methodology This was a cross-sectional study that was conducted in ADDOs and DLDBs. A simulated client method for data collection was used, and a total of 85 ADDOs, located in Mvomero, Kilombero, and Morogoro rural districts, were compared with 60 DLDBs located in Kibaha district. The research assistants posed as simulated clients and requested to buy antibiotics from ADDOs and DLDBs after presenting a case scenario or disease condition. Among the diseases presented were those requiring antibiotics and those usually managed only by oral rehydration salt or analgesics. The simulated clients wanted to know the antibiotics that were available at the shop. The posed questions set a convincing ground to the dispenser either to dispense the antibiotic directly, request a prescription, or refer the patient to a health facility. Proportions were used to summarize categorical variables between ADDOs and DLDBs, and the chi-square test was used to test for statistical difference between the two drug-outlet types in terms of antibiotic-dispensing practice. Results As many as 40% of trained ADDO dispensers no longer worked at the ADDO shops, so some of the shops employed untrained staff. A larger proportion of ADDOs than DLDBs dispensed antibiotics without prescriptions (P = 0.004). The overall results indicate that there was no difference between the two types of shops in terms of adhering to regulations for dispensing antibiotics. However, in some circumstances, eg, antibiotic sale without prescription and no referral made, for complicated cases, ADDOs performed worse than DLDBs. As many as 30% of DLDBs and 35% of ADDOs dispensed incomplete doses of antibiotics. In both ADDOs and DLDBs, fortified procaine penicillin powder was dispensed as topical application for injuries. Conclusion There was no statistical difference between ADDOs and DLDBs in the violation of dispensing practice and both ADDOs and DLDBs expressed poor knowledge of the basic pharmacology of antibiotics. PMID:23403610

Feasibility study of a biocompatible pneumatic dispensing system using mouse 3T3-J2 fibroblasts

NASA Astrophysics Data System (ADS)

Lee, Sangmin; Kim, Hojin; Kim, Joonwon

2017-12-01

This paper presents results for dispensing living cells using a pneumatic dispensing system to verify the feasibility of using this system to fabricate biomaterials. Living cells (i.e., mouse 3T3-J2 fibroblast) were dispensed with different dispensing pressures in order to evaluate the effect of dispensing process on cell viability and proliferation. Based on the results of a live-dead assay, more than 80% of cell viability has been confirmed which was reasonably similar to that in the control group. Furthermore, measurement of cell metabolic activity after dispensing confirmed that the dispensed cell proliferated at a rate comparable to that of the control group. These results demonstrate that the pneumatic dispensing system is a promising tool for fabrication of biomaterials.

Evaluating dispensers loaded with codlemone and pear ester for disruption of codling moth (Lepidoptera: Tortricidae)

USDA-ARS?s Scientific Manuscript database

Polyvinyl chloride polymer (pvc) dispensers loaded with ethyl (E,Z)-2,4-decadienoate (pear ester) plus the sex pheromone, (E,E)-8,10-dodecadien-1-ol (codlemone) of codling moth, Cydia pomonella (L.), were compared with similar dispensers and a commercial dispenser (Isomate®-C Plus) loaded with codle...

Standardizing the Delivery of 20 μL of Hapten During Patch Testing.

PubMed

Selvick, Annika; Stauss, Kari; Strobush, Katrina; Taylor, Lauren; Picard, Alexandra; Doll, Andrea; Reeder, Margo

2016-01-01

The current method for patch test tray assembly requires hand dispensing a small volume of hapten onto chambers. Because of human error, this technique produces inaccurate and inconsistent results. The recommended volume of hapten for patch testing using Finn Chambers is 20 μL. The aims of this study were to create a device that standardizes the delivery of 20 μL and to compare it with the current hand dispensing technique. A device, named the Revolution, was created using the SolidWorks program. Five nurses in our Contact Dermatitis Clinic were asked to load 10 Finn Chambers using the current technique and also using the Revolution. Assembly time, volume of petrolatum, and accuracy of placement were measured. After the 3 trials, the nurses completed a survey on the 2 methods. The amount of petrolatum dispensed using the current technique ranged from 16 to 85 μL, with an average amount of 41.39 μL. The Revolution design dispensed an average of 19.78 μL. The current hand dispensing technique does not allow for accurate and consistent dispensing of 20 μL for patch testing. In contrast, the Revolution is an accurate and consistent device that can help standardize the patch testing method.

Providers' knowledge, attitude and dispensing practices of e-pills in government dispensaries of South district in delhi, India.

PubMed

Kishore, Vertika; Misro, Man M; Nandan, Deoki

2010-01-01

South Delhi is one of the well developed districts in the capital with best public health care facilities. Knowledge, attitude and dispensing practices of emergency contraceptive pills (E-pills) were assessed among health care providers of government dispensaries in South Delhi. A descriptive epidemiological study. Both medical and paramedical (n = 428) providers in 63 government health care facilities were interviewed between August to December 2007 using a semi-structured interview schedule. Among the different categories of the providers, medical officers were observed to be most knowledgeable about E-pills and the pharmacists were the least. The correct prescribed dose of E-pill was known only to 32% of the providers while 49% knew about its right time of intake. Misconceptions and apprehensions for promoting its use were very much prevalent even among medical officers as majority felt that open access to E-pills would increase promiscuity. The dispensing practice of providers was found positively (P < 0.05) correlated with their knowledge. Training resulted a significant (P < 0.05) improvement in knowledge, attitude and dispensing practice of the providers. Knowledge and training combined together contributed 35% to the dispensing practice (R(2) = 0.35). Besides knowledge, behavior change communication strategies should form a part of the training curricula of health care providers that would help to improve the dispensing practice of E-pills.

Alternative Fuels Data Center: Status Update: E25 Dispensers Certified, E15

Science.gov Websites

Alternative Fuels Data Center: Status Update: E25 Dispensers Certified, E15 Warranty Upgraded, and Testing on Ethanol Blends Continues (May 2010) on Facebook Tweet about Alternative Fuels Data Center: Status Update Twitter Bookmark Alternative Fuels Data Center: Status Update: E25 Dispensers Certified, E15 Warranty

Comparing mating disruption of codling moth with standard and meso dispensers loaded with pear ester and codlemone

USDA-ARS?s Scientific Manuscript database

Studies were conducted with hand-applied combo dispensers loaded with the sex pheromone (E,E)-8,10-dodecadien-1-ol (codlemone), and the pear volatile, (E,Z)-2,4-decadienoate (pear ester) for control of codling moth, Cydia pomonella (L.) in apple, Malus domestica Bordkhausen during 2012. Two types of...

The pattern of the discovery of medication errors in a tertiary hospital in Hong Kong.

PubMed

Samaranayake, N R; Cheung, S T D; Chui, W C M; Cheung, B M Y

2013-06-01

The primary goal of reducing medication errors is to eliminate those that reach the patient. We aimed to study the pattern of interceptions to tackle medication errors along the medication use processes. Tertiary care hospital in Hong Kong. The 'Swiss Cheese Model' was used to explain the interceptions targeting medication error reporting over 5 years (2006-2010). Proportions of prescribing, dispensing and drug administration errors intercepted by pharmacists and nurses; proportions of prescribing, dispensing and drug administration errors that reached the patient. Our analysis included 1,268 in-patient medication errors, of which 53.4% were related to prescribing, 29.0% to administration and 17.6% to dispensing. 34.1% of all medication errors (4.9% prescribing, 26.8% drug administration and 2.4% dispensing) were not intercepted. Pharmacy staff intercepted 85.4% of the prescribing errors. Nurses detected 83.0% of dispensing and 5.0% of prescribing errors. However, 92.4% of all drug administration errors reached the patient. Having a preventive measure at each stage of the medication use process helps to prevent most errors. Most drug administration errors reach the patient as there is no defense against these. Therefore, more interventions to prevent drug administration errors are warranted.

Analysis of Underground Storage Tanks System Materials to Increased Leak Potential Associated with E15 Fuel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kass, Michael D; Theiss, Timothy J; Janke, Christopher James

2012-07-01

The Energy Independence and Security Act (EISA) of 2007 was enacted by Congress to move the nation toward increased energy independence by increasing the production of renewable fuels to meet its transportation energy needs. The law establishes a new renewable fuel standard (RFS) that requires the nation to use 36 billion gallons annually (2.3 million barrels per day) of renewable fuel in its vehicles by 2022. Ethanol is the most widely used renewable fuel in the US, and its production has grown dramatically over the past decade. According to EISA and RFS, ethanol (produced from corn as well as cellulosicmore » feedstocks) will make up the vast majority of the new renewable fuel requirements. However, ethanol use limited to E10 and E85 (in the case of flex fuel vehicles or FFVs) will not meet this target. Even if all of the E0 gasoline dispensers in the country were converted to E10, such sales would represent only about 15 billion gallons per year. If 15% ethanol, rather than 10% were used, the potential would be up to 22 billion gallons. The vast majority of ethanol used in the United States is blended with gasoline to create E10, that is, gasoline with up to 10% ethanol. The remaining ethanol is sold in the form of E85, a gasoline blend with as much as 85% ethanol that can only be used in FFVs. Although DOE remains committed to expanding the E85 infrastructure, that market will not be able to absorb projected volumes of ethanol in the near term. Given this reality, DOE and others have begun assessing the viability of using intermediate ethanol blends as one way to transition to higher volumes of ethanol. In October of 2010, the EPA granted a partial waiver to the Clean Air Act allowing the use of fuel that contains up to 15% ethanol for the model year 2007 and newer light-duty motor vehicles. This waiver represents the first of a number of actions that are needed to move toward the commercialization of E15 gasoline blends. On January 2011, this waiver was expanded to include model year 2001 light-duty vehicles, but specifically prohibited use in motorcycles and off-road vehicles and equipment. UST stakeholders generally consider fueling infrastructure materials designed for use with E0 to be adequate for use with E10, and there are no known instances of major leaks or failures directly attributable to ethanol use. It is conceivable that many compatibility issues, including accelerated corrosion, do arise and are corrected onsite and, therefore do not lead to a release. However, there is some concern that higher ethanol concentrations, such as E15 or E20, may be incompatible with current materials used in standard gasoline fueling hardware. In the summer of 2008, DOE recognized the need to assess the impact of intermediate blends of ethanol on the fueling infrastructure, specifically located at the fueling station. This includes the dispenser and hanging hardware, the underground storage tank, and associated piping. The DOE program has been co-led and funded by the Office of the Biomass Program and Vehicle Technologies Program with technical expertise from the Oak Ridge National Laboratory (ORNL) and the National Renewable Energy Laboratory (NREL). The infrastructure material compatibility work has been supported through strong collaborations and testing at Underwriters Laboratories (UL). ORNL performed a compatibility study investigating the compatibility of fuel infrastructure materials to gasoline containing intermediate levels of ethanol. These results can be found in the ORNL report entitled Intermediate Ethanol Blends Infrastructure Materials Compatibility Study: Elastomers, Metals and Sealants (hereafter referred to as the ORNL intermediate blends material compatibility study). These materials included elastomers, plastics, metals and sealants typically found in fuel dispenser infrastructure. The test fuels evaluated in the ORNL study were SAE standard test fuel formulations used to assess material-fuel compatibility within a relatively short timeframe. Initially, these material studies included test fuels of Fuel C, CE10a, CE17a, and CE25a. The CE17a test fuel was selected to represent E15 since surveys have shown that the actual ethanol upper limit can be as high as 17%. Later, CE50a and CE85a test fuels were added to the investigation and these results are being compiled for a follow-on report to be published in 2012. Fuel C was used as the baseline reference and is a 50:50 blend of isooctane and toluene. This particular composition was used to represent premium-grade gasoline and was also used as the base fuel for the ethanol blends, where it is denoted by 'C' in the fuel name. The level of ethanol is represented by the number following the letter E. Therefore a 10% blend of ethanol in Fuel C is written as CE10a, where 'a' represents an aggressive formulation of the ethanol that contains water, NaCl, acetic and sulfuric acids per the SAE J1681 protocol.« less

Trap capture of brown and dusky stink bugs (Hempitera: Pentatomidae) as affected by pheromone dosage in dispensers and dispenser source

USDA-ARS?s Scientific Manuscript database

The brown, Euschistus servus (Say), and dusky, E. tristigmus (Say), stink bugs (Heteroptera: Pentatomidae) readily respond to traps baited with the Euschistus spp. aggregation pheromone methyl (2E, 4Z)-decadienoate. Previous studies examining trap capture of these stink bugs have used either labora...

Elementary school secretaries' experiences and perceptions of administering prescription medication.

PubMed

Price, James H; Dake, Joseph A; Murnan, Judy; Telljohann, Susan K

2003-12-01

This study assessed elementary school secretaries' (n = 385) experiences and perceptions with student prescription medication. Sixty-nine percent (n = 246) reported dispensing student medication, and this group represents the focus of this study. One in four secretaries reported not receiving any training regarding administration of student medication. Of those who were trained, 28% received training of less than one hour, and 24% received training of one to two hours duration. Secretaries generally disliked the responsibility of dispensing medication to students, but felt prepared to do so. Most (63%) administered student medication five days per week. The most commonly administered categories included attention deficit/hyperactivity medication (92%), asthma medication (87%), and antibiotics (68%). Most (85%) reported they had made no medication errors during the past year.

Dispensing patterns for antidiabetic agents in New Zealand: are the guidelines being followed?

PubMed

Murray, Peter; Norris, Hew; Metcalfe, Scott; Betty, Bryan; Young, Vanessa; Locke, Bronwyn

2017-11-10

Type 2 diabetes mellitus (T2DM) is a significant public health issue in New Zealand. Effective management and glycaemic control is critical for reducing diabetes-related complications. Treatment guidelines are well established in New Zealand. Using dispensing data as a proxy for prescribing data, this paper aims to describe the pattern of first- and second-line antidiabetic agent (AA) dispensing for T2DM in New Zealand and assess adherence with treatment guidelines. Analysis of national dispensing data for AA medications using the Pharmaceutical Collection database from 2007/08 to 2015/16. Metformin monotherapy remains the most commonly prescribed first-line T2DM medication prescribed, accounting for 85% of initial agents prescribed. Sulfonylureas are the most common second-line agents used, accounting for 70% of all second-line agents. There is a high degree of adherence with the T2DM treatment guidelines in New Zealand.

Magnetic rotational hysteresis study on spherical 85-160 nm Fe3O4 particles

NASA Astrophysics Data System (ADS)

Schmidbauer, E.

1988-05-01

Rotational hysteresis losses Wr were determined as a function of magnetic field H for dispensed spherical Fe3O4 particles of mean grain sizes 85 nm, 127 nm and 162 nm between 78 K and 294 K. The observed Wr-H curves are compared with theoretical curves for single domain particles. The analysed particles reveal centers of high magnetic anisotropy. Such centers can be of importance during the generation of a thermoremanent magnetization, as they may be the origin of enhanced magnetic stability.

Control and monitoring of codling moth (Lepidoptera: Tortricidae) in walnut orchards treated with novel high-load, low-density “meso” dispensers of sex pheromone and pear ester

USDA-ARS?s Scientific Manuscript database

Novel low-density per ha “meso” dispensers loaded with both pear ester, ethyl (E,Z)-2,4-decadienoate, kairomone and codlemone, (E,E)-8,10-dodecadien-1-ol, the sex pheromone of codling moth, Cydia pomonella (L)., were evaluated versus meso dispensers loaded with pheromone-alone for their mating disru...

Physician drug dispensing in Switzerland: association on health care expenditures and utilization.

PubMed

Trottmann, Maria; Frueh, Mathias; Telser, Harry; Reich, Oliver

2016-07-08

Several countries recently reassessed the roles of drug prescribing and dispensing, either by enlarging pharmacists' rights to prescribe (e.g. the US and the United Kingdom) or by limiting physicians' rights to dispense (e.g. Taiwan and South Korea). While integrating the two roles might increase supply and be convenient for patients, concern is that drug mark-ups incite providers to prescribe unnecessary drugs. We aimed to assess the association of physician dispensing (PD) in Switzerland on various outcomes. We performed a retrospective cohort study, using health care claims data for patients in the year 2013. The analysis of the association of PD was perfomed using a large patient level dataset and several target variables, including the number of different chemical agents, share of generic drugs, number of visits to physicians and expenditures. Different multivariate econometric models were applied in order to capture the association PD on the target variables. A total of 101'784 patients were enrolled in 2013, whereas 54 % were PD patients. We find that PD is associated with lower pharmaceutical expenditure per patient, which can be explained by an increased use of generic drugs. The decrease is compensated by higher use of physician services. We find no significant impact of physician dispensing on total health care expenditure. Our study offers insights for policy makers who are (re-)considering the separation between drug prescribing and dispensing, either by allowing physicians to dispense or pharmacists to prescribe certain drugs. In terms of total health care expenditures, we find no difference between the two systems, so we are doubtful that changing dispensing rights are a good measure to contain cost, at least in Switzerland.

Brand versus generic dispensing trend for ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg (oral dosage forms) among pharmacies of Karachi, Pakistan.

PubMed

Zehra, Fatima; Naqvi, Atta Abbas; Tasneem, Sumbul; Ahmad, Rizwan; Ahmad, Niyaz; Shamsi, Adnan Zia; Asghar, Naqiya Ali; Khan, Ghufran Ullah

2017-01-01

Pakistan spends 0.7% of its gross domestic product on health. The public sector health-care system provides services to 22% of population thus paving the way for a dominant private sector. Patients in Pakistan mostly pay their medical expenses directly, and 64% of the health expenditures are borne by the household. Expenditure on medicine constitutes 43% of the total household expenditure. A quantitative cross-sectional study was conducted in Karachi, Pakistan, for a month. It was aimed at gathering response from different pharmacies to understand the brand versus generic dispensing trend of ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg oral dosage forms. The study employed convenience sampling and used a survey checklist. The data gathered was entered in SPSS version 22. The mean price per tablet for ciprofloxacin brand and generic was reported at Pakistani Rupees (PKR) 48.44 and PKR 26.85, respectively. The trend for dispensing ciprofloxacin highlighted a split in the market between brand (51%) and generic (49%). For levofloxacin brand and generic, the price per tablet was reported at PKR 36.50 and PKR 36.15 respectively, and despite same price, the market was dominated by generic levofloxacin (92%). Due to a price difference between brand and generic moxifloxacin, i.e., PKR 129.44 and PKR 71.91, respectively, the market was mostly occupied by the generic form (75%). Pricing mechanism must be revisited, and the authorities should take stern actions against any illegitimate price hike. The surging burden of drug expenditure on poorer sections of the society must be addressed by the government on an urgent basis.

Laboratory monitoring of patients treated with antihypertensive drugs and newly exposed to non steroidal anti-inflammatory drugs: a cohort study.

PubMed

Fournier, Jean-Pascal; Lapeyre-Mestre, Maryse; Sommet, Agnès; Dupouy, Julie; Poutrain, Jean-Christophe; Montastruc, Jean-Louis

2012-01-01

Drug-Drug Interactions between Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blocker (ARBs) or diuretics can lead to renal failure and hyperkalemia. Thus, monitoring of serum creatinine and potassium is recommended when a first dispensing of NSAID occur in patients treated with these drugs. We conducted a pharmacoepidemiological retrospective cohort study using data from the French Health Insurance Reimbursement Database to evaluate the proportion of serum creatinine and potassium laboratory monitoring in patients treated with ACEI, ARB or diuretic and receiving a first dispensing of NSAID. We described the first dispensing of NSAID among 3,500 patients of a 4-year cohort (6,633 patients treated with antihypertensive drugs) and analyzed serum creatinine and potassium laboratory monitoring within the 3 weeks after the first NSAID dispensing. General Practitioners were the most frequent prescribers of NSAIDs (85.5%, 95% CI: 84.3-86.6). The more commonly prescribed NSAIDs were ibuprofen (20%), ketoprofen (15%), diclofenac (15%) and piroxicam (12%). Serum creatinine and potassium monitoring was 10.7% (95% CI: 9.5-11.8) in patients treated by ACEIs, ARBs or diuretics. Overall, monitoring was more frequently performed to women aged over 60, treated with digoxin or glucose lowering drugs, but not to patients treated with ACEIs, ARBs or diuretics. Monitoring was more frequent when NSAIDs' prescribers were cardiologists or anesthesiologists. Monitoring of serum creatinine and potassium of patients treated with ACEIs, ARBs or diuretics and receiving a first NSAID dispensing is insufficiently performed and needs to be reinforced through specific interventions.

Cbl-family ubiquitin ligases and their recruitment of CIN85 are largely dispensable for epidermal growth factor receptor endocytosis

PubMed Central

Ahmad, Gulzar; Mohapatra, Bhopal; Schulte, Nancy A.; Nadeau, Scott; Luan, Haitao; Zutshi, Neha; Tom, Eric; Ortega-Cava, Cesar; Tu, Chun; Sanada, Masashi; Ogawa, Seishi; Toews, Myron L.; Band, Vimla; Band, Hamid

2014-01-01

Members of the Casitas B-Lineage Lymphoma (Cbl) family (Cbl, Cbl-b and Cbl-c) of ubiquitin ligases serve as negative regulators of receptor tyrosine kinases (RTKs). An essential role of Cbl-family protein-dependent ubiquitination for efficient ligand-induced lysosomal targeting and degradation is now well-accepted. However, a more proximal role of Cbl and Cbl-b as adapters for CIN85-endophilin recruitment to mediate ligand-induced initial internalization of RTKs is supported by some studies but refuted by others. Overexpression and/or incomplete depletion of Cbl proteins in these studies is likely to have contributed to this dichotomy. To address the role of endogenous Cbl and Cbl-b in the internalization step of RTK endocytic traffic, we established Cbl/Cbl-b double-knockout (DKO) mouse embryonic fibroblasts (MEFs) and demonstrated that these cells lack the expression of both Cbl-family members as well as endophilin A, while they express CIN85. We show that ligand-induced ubiquitination of EGFR, as a prototype RTK, was abolished in DKO MEFs, and EGFR degradation was delayed. These traits were reversed by ectopic human Cbl expression. EGFR endocytosis, assessed using the internalization of 125I-labeled or fluorescent EGF, or of EGFR itself, was largely retained in Cbl/Cbl-b DKO compared to wild type MEFs. EGFR internalization was also largely intact in Cbl/Cbl-b depleted MCF-10A human mammary epithelial cell line. Inducible shRNA-mediated knockdown of CIN85 in wild type or Cbl/Cbl-b DKO MEFs had no impact on EGFR internalization. Our findings, establish that, at physiological expression levels, Cbl, Cbl-b and CIN85 are largely dispensable for EGFR internalization. Our results support the model that Cbl-CIN85-endophilin complex is not required for efficient internalization of EGFR, a prototype RTK. PMID:25449262

Risk Factors for Fatal Hyperglycaemia Confirmed by Forensic Postmortem Examination - A Nationwide Cohort in Sweden.

PubMed

Walz, Lotta; Jönsson, Anna K; Zilg, Brita; Östgren, Carl Johan; Druid, Henrik

2016-01-01

The aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia, which could predispose potentially preventable deaths in individuals on glucose lowering drugs. A retrospective register-based case-control study conducted on a nationwide cohort with individuals who died due to hyperglycaemia as determined by forensic postmortem examination, in Sweden August 2006 to December 2012. Vitreous glucose was used to diagnose hyperglycaemia postmortem. The forensic findings stored in the National Forensic Medicine Database were linked to nationwide registers. Cases that died due to confirmed hyperglycemia with dispensed glucose lowering drugs were identified and living controls with dispensed glucose lowering drugs were randomly selected in the Swedish prescribed drug register and matched on age and sex. Information on comorbidities, dispensed pharmaceuticals, clinical data and socioeconomic factors were obtained for cases and controls. Adjusted multiple logistic regression models were used to identify risk factors associated with fatal hyperglycaemia. During the study period 322 individuals, mostly males (79%) with the mean age of 53.9 years (SD.± 14) died due to confirmed hyperglycaemia. Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%CI,1.96, 9.85), poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27), inadequate refill-adherence before death (OR = 3.87; 95%CI,1.99, 7.53), microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79), psychiatric illness (OR = 2.30; 95% CI,1.32, 4.01), substance abuse (OR = 8.85; 95%CI,2.34, 35.0) and/or living alone (OR = 2.25; 95%CI,1.21, 4.18). Our results demonstrate the importance of clinical attention to poor glycaemic control in subjects with psychosocial problems since it may indicate serious non-adherence, which consequently could lead to fatal hyperglycaemia.

Gender and age differences in medications dispensed from a national chain drugstore.

PubMed

Anthony, Marietta; Lee, Kwan Y; Bertram, Carl T; Abarca, Jacob; Rehfeld, Rick A; Malone, Daniel C; Freeman, Marlene; Woosley, Raymond L

2008-06-01

Our objective was to compare sex and age differences in the medications dispensed in pharmacies from a large national drugstore chain. Using a list for the 200 most commonly prescribed medicines, we assessed prescriptions dispensed by a large national chain drug store over 1 year (2002-2003). The analysis used U.S. census data adjusted for the population by sex and age and weighted by the number of pharmacies per state. Results are reported as an odds ratio (OR) of prescriptions dispensed to females and males. Under age 18, 24 drug classes were dispensed more commonly to females (OR > 1) and 18 drug classes more commonly to males (OR < 1). In the 18-24 age group, 48 of 53 drug classes were dispensed more frequently to females. Across other adult groups, females were dispensed more medications than males for 156 of 180 medications. There was greater dispensing to females of antibiotics (OR = 1.74, 95% confidence interval [CI] 1.74-1.74), analgesics (OR = 1.70, 95% CI 1.70-1.70), antihistamines and sympathomimetics (OR = 1.46, 95% CI 1.45-1.46), benzodiazapines (OR = 2.08, 95% CI 2.07-2.08), antidepressants (OR = 2.40, 95% CI 2.39-2.40), diuretics (OR = 1.9328, 95% CI 1.93-1.94), and thyroid drugs (OR = 4.80, 95% CI 4.78-4.82). However, males had higher dispensing of antianginal drugs (OR = 0.84, 95% CI 0.83-0.85), anticoagulants (OR = 0.89, 95% CI 0.88-0.90), glycosides (OR = 0.80, 95% CI 0.79-0.81), and antihypertensives (OR = 0.91, 95% CI 0.91-0.91). More females were dispensed propoxyphene with acetaminophen (OR = 2.23, 95% CI 2.23-2.24), which has been associated with adverse outcomes (hospitalizations, emergency department visits, and deaths). Females, especially during the reproductive years, are dispensed more medications than males.

Methods and systems for integrating fluid dispensing technology with stereolithography

DOEpatents

Medina, Francisco; Wicker, Ryan; Palmer, Jeremy A.; Davis, Don W.; Chavez, Bart D.; Gallegos, Phillip L.

2010-02-09

An integrated system and method of integrating fluid dispensing technologies (e.g., direct-write (DW)) with rapid prototyping (RP) technologies (e.g., stereolithography (SL)) without part registration comprising: an SL apparatus and a fluid dispensing apparatus further comprising a translation mechanism adapted to translate the fluid dispensing apparatus along the Z-, Y- and Z-axes. The fluid dispensing apparatus comprises: a pressurized fluid container; a valve mechanism adapted to control the flow of fluid from the pressurized fluid container; and a dispensing nozzle adapted to deposit the fluid in a desired location. To aid in calibration, the integrated system includes a laser sensor and a mechanical switch. The method further comprises building a second part layer on top of the fluid deposits and optionally accommodating multi-layered circuitry by incorporating a connector trace. Thus, the present invention is capable of efficiently building single and multi-material SL fabricated parts embedded with complex three-dimensional circuitry using DW.

Pharmaceutic factors affecting pediatric compliance.

PubMed

Mattar, M E; Markello, J; Yaffe, S J

1975-01-01

Evaluation of treatment given at home was studied in children with otitis media who were seen in an outpatient clinic. Full compliance was present in only 5% of the initial 100 patients (Study A). Practical factors limiting their compliance included inadequate dispensing of medication at drug stores, 15%; incorrect therapy schedule, 36%; early termination, 37%; spilled medicine, 7%; therapy shared, 5%. Because of these findings, a plan was implemented (Study B) in which hospital pharmacy personnel gave patient families verbal and written instructions for administering medications that were dispensed, together with a calibrated measuring device and a calendar to record doses taken. Full compliance was raised to 51% in this pilot group (of 33 patients) as compared with 8.5% in 20 concurrent controls who went to neighborhood drug stores. The importance of detailed therapy instructions is stressed. The potential role of the pharmacist in improving compliance is demonstrated.

Laboratory Monitoring of Patients Treated with Antihypertensive Drugs and Newly Exposed to Non Steroidal Anti-Inflammatory Drugs: A Cohort Study

PubMed Central

Fournier, Jean-Pascal; Lapeyre-Mestre, Maryse; Sommet, Agnès; Dupouy, Julie; Poutrain, Jean-Christophe; Montastruc, Jean-Louis

2012-01-01

Background Drug-Drug Interactions between Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blocker (ARBs) or diuretics can lead to renal failure and hyperkalemia. Thus, monitoring of serum creatinine and potassium is recommended when a first dispensing of NSAID occur in patients treated with these drugs. Methods We conducted a pharmacoepidemiological retrospective cohort study using data from the French Health Insurance Reimbursement Database to evaluate the proportion of serum creatinine and potassium laboratory monitoring in patients treated with ACEI, ARB or diuretic and receiving a first dispensing of NSAID. We described the first dispensing of NSAID among 3,500 patients of a 4-year cohort (6,633 patients treated with antihypertensive drugs) and analyzed serum creatinine and potassium laboratory monitoring within the 3 weeks after the first NSAID dispensing. Results General Practitioners were the most frequent prescribers of NSAIDs (85.5%, 95% CI: 84.3–86.6). The more commonly prescribed NSAIDs were ibuprofen (20%), ketoprofen (15%), diclofenac (15%) and piroxicam (12%). Serum creatinine and potassium monitoring was 10.7% (95% CI: 9.5–11.8) in patients treated by ACEIs, ARBs or diuretics. Overall, monitoring was more frequently performed to women aged over 60, treated with digoxin or glucose lowering drugs, but not to patients treated with ACEIs, ARBs or diuretics. Monitoring was more frequent when NSAIDs' prescribers were cardiologists or anesthesiologists. Conclusion Monitoring of serum creatinine and potassium of patients treated with ACEIs, ARBs or diuretics and receiving a first NSAID dispensing is insufficiently performed and needs to be reinforced through specific interventions. PMID:22479557

Community Pharmacistsꞌ Role in Controlling Bacterial Antibiotic Resistance in Aleppo, Syria

PubMed Central

Mansour, Ossama; Al-Kayali, Rawaa

2017-01-01

Antibiotic resistance is a major public health concern. This study was conducted to evaluate the knowledge, attitudes of community pharmacists regarding antibiotic use and potential drug resistance besides assessing their behaviors about dispensing antibiotic without prescription and correlation of the outcomes with demographic variables. A cross-sectional survey was conducted on a random sample of 250 pharmacies in Aleppo, using validated self-administered questionnaire. The total scores of the pharmacistsʹ knowledge and attitudes were correlated with participant demographics using Chi-squared test. One-hundered-seventy-three pharmacies out of 250 agreed to participate in the study. The overall prevalence of dispensing antibiotic without prescription was 85.5%. Only 30.8% of participants exhibited good attitude and 37% had adequate knowledge about antibiotic resistance. Good attitude was strongly correlated with age (P = 0.023), years of experience (P = 0.007), socioeconomic location of the pharmacy (P = 0.009) and number of clinics near pharmacy (P = 0.008). The results of this study confirmed that dispensing antibiotic without prescription is a common practice in Aleppo pharmacies despite being unlawful. The half of community pharmacists has a poor attitude and inadequate knowledge with regard to antibiotic resistance, reflecting the need for awareness-raising campaigns directed to community pharmacists to equip them for their main role in the community. PMID:29552070

Counselling practices in community pharmacies in Riyadh, Saudi Arabia: a cross-sectional study.

PubMed

Alaqeel, Sinaa; Abanmy, Norah O

2015-12-15

Community pharmacists play a crucial role in optimising medication use and improving patient outcomes, whilst preventing medication misuse and reducing costs. Evidence suggests that pharmacists counselling improves clinical outcomes, quality of life, drug and disease knowledge and reduces health service utilisation. This study aims to investigate the counselling practices of community pharmacists in Riyadh, the capital of Saudi Arabia. The study consisted of two parts: simulated patients (SPs) visits to observe actual counselling practices, and a cross-sectional survey of community pharmacists to assess their reported counselling practices. In the SPs method, there were four scenarios involving four medications. Scenarios 1 and 2 concerned drug-drug interactions, scenario 3 concerned the proper time of administration, and scenario 4 concerned side effects. The simulated visits were conducted between April and May 2012. A four-sections questionnaire was distributed in the same period. We conducted 161 simulated visits. Out of the 161 visits a medicine was dispensed in 150 visits. When SPs requested medications, pharmacists asked questions during 15 visits (10.0%), provided information during 7 visits (4.6%), and both asked questions and provided information, i.e. provided counselling, during 4 visits (2.6%). When the SPs started to be inquisitive and demanded information, pharmacists asked SPs questions during 71 visits (47.3%), provided information during 150 visits (100%), and both asked questions and provided information, i.e. provided counselling, during 65 visits (43.3%). Information regarding dose was the most common type of information provided in 146 visits (97.3%). After the SPs started to be inquisitive and probed for information, only 10% were counselled on precautions. In the cross-sectional survey, four hundred pharmacists were approached and 350 agreed to participate in the questionnaire (87% response rate). Of the respondents, 223 (63.7%) reported that they usually or always tell the patient about the purpose of medicines or the diagnosis, 302 (86.2%) reported that they usually or always give patient information on how to use or apply the medicine; 299 (85.3%) said they were satisfied with their counselling practices. The present study highlights the current deficiencies in appropriate dispensing practices and medication counselling at community pharmacies in Saudi Arabia. Policy makers, stakeholders, and researchers should collaborate to design interventions to improve the current dispensing practices at community pharmacies across the country.

Monitoring codling moth (Lepidoptera: Tortricidae) in orchards treated with pear ester and sex pheromone combo dispensers

USDA-ARS?s Scientific Manuscript database

Lures for monitoring codling moth, Cydia pomonella (L.), were tested in apple and walnut blocks treated with Cidetrak CM-DA Combo dispensers loaded with pear ester, ethyl (E, Z)-2,4-decadienoate (PE), and sex pheromone (E,E)-8,10-dodecadien-1-ol (codlemone). Total and female moth catches with combin...

Risk Factors for Fatal Hyperglycaemia Confirmed by Forensic Postmortem Examination - A Nationwide Cohort in Sweden

PubMed Central

Walz, Lotta; Jönsson, Anna K.; Zilg, Brita; Östgren, Carl Johan; Druid, Henrik

2016-01-01

Aims/Hypothesis The aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia, which could predispose potentially preventable deaths in individuals on glucose lowering drugs. Methods A retrospective register-based case-control study conducted on a nationwide cohort with individuals who died due to hyperglycaemia as determined by forensic postmortem examination, in Sweden August 2006 to December 2012. Vitreous glucose was used to diagnose hyperglycaemia postmortem. The forensic findings stored in the National Forensic Medicine Database were linked to nationwide registers. Cases that died due to confirmed hyperglycemia with dispensed glucose lowering drugs were identified and living controls with dispensed glucose lowering drugs were randomly selected in the Swedish prescribed drug register and matched on age and sex. Information on comorbidities, dispensed pharmaceuticals, clinical data and socioeconomic factors were obtained for cases and controls. Adjusted multiple logistic regression models were used to identify risk factors associated with fatal hyperglycaemia. Results During the study period 322 individuals, mostly males (79%) with the mean age of 53.9 years (SD.± 14) died due to confirmed hyperglycaemia. Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%CI,1.96, 9.85), poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27), inadequate refill-adherence before death (OR = 3.87; 95%CI,1.99, 7.53), microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79), psychiatric illness (OR = 2.30; 95% CI,1.32, 4.01), substance abuse (OR = 8.85; 95%CI,2.34, 35.0) and/or living alone (OR = 2.25; 95%CI,1.21, 4.18). Conclusions/Interpretation Our results demonstrate the importance of clinical attention to poor glycaemic control in subjects with psychosocial problems since it may indicate serious non-adherence, which consequently could lead to fatal hyperglycaemia. PMID:27768720

32 CFR 776.85 - Effect of separate proceeding.

Code of Federal Regulations, 2010 CFR

2010-07-01

... that issue during an ethics investigation. A subsequent ethics investigation based on such misconduct... the basis for ethics charges under this instruction, the Rules Counsel may dispense with the preliminary inquiry and proceed directly with an ethics investigation. (c) In those cases in which a covered...

Dispensing medications without prescription at Saudi community pharmacy: Extent and perception

PubMed Central

Al-Mohamadi, A.; Badr, A.; Bin Mahfouz, L.; Samargandi, D.; Al Ahdal, A.

2011-01-01

Objective To investigate the dispensing behavior of pharmacists in retail pharmacy practice and to assess their attitude toward dispensing non-OTC drugs and scrutinize the causes of their malpractice; if in fact was perceived. Method Between December 2010 and January 2011 retail pharmacies in Jeddah-KSA were visited randomly by a number of voluntary collaborators who played the role of asking for one or more of the following medications without providing a prescription: Co-amoxiclav (Augmentin) or Cefaclor (Ceclor), Captopril (Capoten) and Fluoxetine (Prozac). Results A total of 60 pharmacies were randomly included in this study; 100% of the pharmacists working were male, 96.7% of them were non-Saudis and only 2 (3.3%) were Saudis. In a total of 119 drug requests, almost all pharmacists (97.9%) handed out the antibiotic immediately, 100% dispensed captopril and 89.5% gave the antipsychotic simply by following the collaborator’s request without even asking for a doctor’s prescription. In the second part of the study (where a mini-questionnaire is administered), 85% of the pharmacists agreed to answer the mini-questionnaire, and 15% refused to participate. The highest reason given for their wrongdoing, was for that if the pharmacist did not, others – of neighboring pharmacies – would do the same, followed by that there is no available OTC list. Conclusion The study confirmed that pharmacists are still violating the law, which is leading to a profound malpractice in retail pharmacies around the country. Consequently, regulations should be reviewed and structured educational campaigns are a must to both pharmacists and public. The OTC list should be generated, implemented, and monitored by Saudi regulators and penalize violators. PMID:23960815

Pattern of drug therapy problems and interventions in ambulatory patients receiving antiretroviral therapy in Nigeria

PubMed Central

Ojeh, Victor B.; Naima, Nasir; Abah, Isaac O.; Falang, Kakjing D.; Lucy, Ogwuche; London, Ibrahim; Dady, Christiana; Agaba, Patricia; Agbaji, Oche

2015-01-01

Objectives: We describe the frequency and types of drug therapy problems (DTPs), and interventions carried out to resolve them, among a cohort of HIV-infected patients on ART in Jos, Nigeria. Methods: A prospective pharmacists’ intervention study was conducted between January and August 2012 at the outpatient HIV clinic of the Jos University Teaching Hospital (JUTH). Pharmacists identified DTPs and made recommendations to resolve them. The main outcome measures were number of DTPs encountered, interventions proposed and acceptance rate of recommendations. Results: A total of 42,416 prescriptions were dispensed to 9339 patients during the eight months study. A total of 420 interventions (Intervention rate of 1 per 100 prescriptions) were made to resolve DTPs in 401 (4.3%) patients with a mean age of 41 (SD=10) years, and made up of 73% females. DTPs encountered were drug omission (n=89, 21.2%), unnecessary drug (n=55, 13.1%) and wrong drug indication (n=55, 13.1%). Recommendations offered included; Addition of another drug to the therapy (n=87, 20.7%), rectification of incomplete prescriptions (n=85, 20.2%), change of drug or dosage (n=67, 16.0%), and discontinuation of the offending drug (n=59, 14.0%). A total of 389 (93%) out of 420 of the recommendations were accepted. In all, 50.4% (212) of the problematic prescriptions were changed and dispensed, 22.2% (89) were clarified and dispensed, while wrong identities were corrected in 11.7% (49). However, 7.5% (30) prescriptions were dispensed as prescribed, 5.2% (21) were not dispensed, and 3% (12) were unresolved. Conclusion: Our findings suggest that pharmacists-initiated interventions can ameliorate DTPs in patients receiving ART given the high intervention acceptance rate recorded. The implication of this finding is that pharmacists with requisite training in HIV pharmacotherapy are an excellent resource in detecting and minimizing the effect of antiretroviral drug-related errors. PMID:26131046

Investigating dormant-season application of pheromone in citrus to control overwintering and spring populations of Phyllocnistis citrella (Lepidoptera: Gracillariidae).

PubMed

Keathley, Craig P; Stelinski, Lukasz L; Lapointe, Stephen L

2016-07-01

The leafminer, Phyllocnistis citrella Stainton, reproduces on leaf flush during winter. Deployment of pheromone during winter could suppress moth populations in spring and summer more than a spring application alone. We tested the primary pheromone component of P. citrella, (Z,Z,E)-7,11,13-hexadecatrienal, released gradually over several months from elastomeric dispensers in a citrus grove in 6.4 ha main plots in winter and/or 3.2 ha subplots in spring (834 mg triene ha(-1) ) and evaluated moth catch and leaf mining. After winter treatment, dispensers provided >85% disruption of male moth catch in traps for 37 weeks, and after spring treatment they provided >92% disruption for 26 weeks, but there was only a 12% reduction in leaf infestation in spring. Two applications were no better than only a single application in spring. Disruption of moth catch was weaker in treated plots where traps were placed high (3.1 m) rather than low (1.6 m) in the tree canopy. Dispensers provided effective and persistent disruption of male catch in pheromone-baited monitoring traps but were minimally effective in reducing leaf infestation by P. citrella. Winter application of pheromone did not reduce leaf mining in spring compared with spring application alone. Tops of trees may have provided a refuge for mating. Published 2015. This article is a U.S. Government work and is in the public domain in the USA. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Back-gated graphene anode for more efficient thermionic energy converters

DOE PAGES

Yuan, Hongyuan; Riley, Daniel C.; Shen, Zhi-Xun; ...

2016-12-15

Thermionic energy converters (TECs) are a direct heat-to-electricity conversion technology with great potential for high efficiency and scalability. However, space charge barrier in the inter-electrode gap and high anode work function are major obstacles toward realizing high efficiency. Here, we demonstrate for the first time a prototype TEC using a back-gated graphene anode, a barium dispenser cathode, and a controllable inter-electrode gap as small as 17 µm, which simultaneously addresses these two obstacles. This leads to an electronic conversion efficiency of 9.8% at cathode temperature of 1000 °C, the highest reported by far. We first demonstrate that electrostatic gating ofmore » graphene by a 20 nm HfO 2 dielectric layer changes the graphene anode work function by 0.63 eV, as observed from the current-voltage characteristics of the TEC. Next, we show that the efficiency increases by a factor of 30.6 by reducing the gap from 1 mm down to 17 µm, after a mono-layer of Ba is deposited on graphene by the dispenser cathode. Lastlu, we show that electrostatic gating of graphene further reduces the graphene work function from 1.85 to 1.69 eV, leading to an additional 67% enhancement in TEC efficiency. Note that the overall efficiency using the back-gated graphene anode is 6.7 times higher compared with that of a TEC with a tungsten anode and the same inter-electrode gap.« less

Back-gated graphene anode for more efficient thermionic energy converters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yuan, Hongyuan; Riley, Daniel C.; Shen, Zhi-Xun

Thermionic energy converters (TECs) are a direct heat-to-electricity conversion technology with great potential for high efficiency and scalability. However, space charge barrier in the inter-electrode gap and high anode work function are major obstacles toward realizing high efficiency. Here, we demonstrate for the first time a prototype TEC using a back-gated graphene anode, a barium dispenser cathode, and a controllable inter-electrode gap as small as 17 µm, which simultaneously addresses these two obstacles. This leads to an electronic conversion efficiency of 9.8% at cathode temperature of 1000 °C, the highest reported by far. We first demonstrate that electrostatic gating ofmore » graphene by a 20 nm HfO 2 dielectric layer changes the graphene anode work function by 0.63 eV, as observed from the current-voltage characteristics of the TEC. Next, we show that the efficiency increases by a factor of 30.6 by reducing the gap from 1 mm down to 17 µm, after a mono-layer of Ba is deposited on graphene by the dispenser cathode. Lastlu, we show that electrostatic gating of graphene further reduces the graphene work function from 1.85 to 1.69 eV, leading to an additional 67% enhancement in TEC efficiency. Note that the overall efficiency using the back-gated graphene anode is 6.7 times higher compared with that of a TEC with a tungsten anode and the same inter-electrode gap.« less

Community pharmacy practice in Japan--results of a survey.

PubMed

Iguchi, S; Ohnishi, M; Nishiyama, T; Hosono, K; Umezawa, C

1998-06-01

To survey the present condition of community pharmacies as future sites for pharmacy students' externship in Japan. A questionnaire consisting of 55 questions was sent to 425 graduates from Kobe Gakuin University, School of Pharmacy, who owned or worked in community pharmacies. Of the 85 responders, about half were owners and half employees of pharmacies. Ninety per cent of pharmacy owners operated three and fewer pharmacies. Fifty per cent of pharmacies only dispensed drugs, 32% handled both OTC drugs and dispensing, and 18% handled only OTC drugs. Among the 44 dispensing pharmacies, 16 were one-to-one type pharmacies, 13 were located in front of the big medical institutions, nine dispensed prescriptions from various medical institutions and five were hospital-owned pharmacies. Forty-five per cent of pharmacies employed 1-4 part-time pharmacists and 52% employed 1-4 pharmacist assistants. Thirty-one per cent of prescriptions came from internal medicine departments and the daily number of prescriptions dispensed by each pharmacy was in the range 10-99 for 41% of the pharmacies and 100-199 for 36% of the pharmacies. The average daily number of prescriptions dispersed by each pharmacist was in the range 30-39 for 29% of pharmacies and in the range 20-29 for 22% of pharmacies. Pharmaceutical information was provided at 73% of pharmacies and patients were counselled orally on their medication at 80% of pharmacies. Patients' medication histories were recorded at 88% pharmacies. Only 15% of pharmacies conducted patients' medication counselling at their home, but 34% of pharmacies were planning to start this service. Community pharmacists attended very few professional meetings or continuing education programmes and only 20% of them obtained information through computers. Forty-seven pharmacists out of the 85 obtained their information from medical representatives of pharmaceutical companies and 32 pharmacists through marketing specialists of wholesalers. Ninety per cent of community pharmacists who responded thought that separation of prescribing and dispensing functions would progress further in the future and 50% of them thought positively about the future social status of pharmacists. Most of our graduates who responded were willing to accept pharmacy students from Kobe Gakuin University as externs at their pharmacies. Despite the low response rate, our survey suggests that community pharmacy in Japan requires substantial improvement. This is to ensure that pharmacists working in that sector can provide the quality information that is required for the optimum management of patients and that the environment is suitable for pharmacy externships.

Dispensing behaviour of pharmacies in prescription drug markets.

PubMed

Guhl, Dennis; Stargardt, Tom; Schneider, Udo; Fischer, Katharina E

2016-02-01

We aim to investigate pharmacies' dispensing behaviour under the existing dispensing regulations in Germany. Using administrative data, we performed a cross-sectional retrospective study to analyse whether the competitive environment and pharmacy characteristics, i.e., organisation, lead to dispensing choices aimed at by third-party payers. We specified generalised linear models with the share of imported pharmaceuticals, generic share, and share of preferred brands as dependent variables. The final dataset contained 49,260,902 prescriptions from 16,797 pharmacies. The average share of imported pharmaceuticals across the pharmacies was 18.4% (standard deviation (SD) 8.8), the average generic share was 92.8% (SD 2.1), and compliance with preferred brands was 81.3% (SD 5.9). Pharmacies with little competition used fewer imported pharmaceuticals (p<0.001), generics (p<0.001) and preferred brands (p<0.001); less organised pharmacies yielded similar results. The difference in outcomes between pharmacies in the first and 4th quartiles of the pharmacy organisation variable is 17.4% vs. 17.0% for share of imported pharmaceuticals, 92.8% vs. 92.7% for generic share and 81.9% vs. 81.1% for compliance with preferred brands. We show that pharmacies' dispensing choices meet the aims of payers at high levels. However, dispensing behaviour varies between pharmacies. Increasing competition among pharmacies and targeting pharmacies with high shares of bill auditing seem viable options to improving dispensing behaviour as defined by payers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Patterns of use for brand-name versus generic oral bisphosphonate drugs in Ontario over a 13-year period: a descriptive study.

PubMed

Fraser, Lisa-Ann; Albaum, Jordan M; Tadrous, Mina; Burden, Andrea M; Shariff, Salimah Z; Cadarette, Suzanne M

2015-01-01

Bisphosphonates are the first-line therapy for the treatment of osteoporosis. In the province of Ontario, the Ontario Drug Benefit Program funds medications for patients aged 65 years and older. The Ontario Drug Benefit Program has a generic substitution policy that requires lower-cost generic drugs to be dispensed when they are available. However, there is controversy surrounding the efficacy and tolerability of generic bisphosphonates. The objective of this study was to describe patterns in the use of brand-name versus generic formulations when dispensing oral bisphosphonate over a 13-year period. We identified all osteoporotic preparations for alendronate and risedronate that were dispensed through the Ontario Drug Benefit Program from 2001 to 2014. We stratified our sample into community-dwelling residents and residents in long-term care facilities. The number of prescriptions dispensed per month were plotted to illustrate trends over time. We found a rapid switch from brand-name to generic bisphosphonate equivalents immediately after the generic became available on the Ontario Drug Benefit formulary, with generics accounting for > 88% of dispensed drug within 2 months. We also observed a reduction in the number of generic drugs dispensed each time a new brand-name alternative (e.g., monthly risedronate, weekly alendronate plus vitamin D) was introduced to the formulary. The dispensing trends were similar in the community and long-term care settings. The Ontario Drug Benefit Program generic substitution policy resulted in rapid uptake of generic oral bisphosphonates among seniors in Ontario. However, there was a switch away from generic medications to new brand-name alternatives whenever they were introduced to the formulary. Therefore, some patients continued to use brand-name bisphosphonate despite the availability of generic options.

Recommendations and requirements for soap and hand rub dispensers in healthcare facilities.

PubMed

Assadian, Ojan; Kramer, Axel; Christiansen, Bärbel; Exner, Martin; Martiny, Heike; Sorger, Arno; Suchomel, Miranda

2012-01-01

Hand hygiene is one of the most important measures to prevent transmission of infectious agents and plays a major role in prevention of infection in any type of healthcare setting. While requirements for the efficacy of hand disinfectants are defined in European testing norms such as the EN 1500 for hygienic hand disinfection or EN 12791 for surgical hand preparation, no specific recommendations for hand rub dispensers and liquid soap dispensers have been given yet. Therefore, the intention of the present recommendation on soap and hand rub dispensers in healthcare facilities is to close this gap and to enhance future improvement of dispenser functionality and design. Regardless of manufacture and design of a hand rub or liquid soap dispensers the following requirements shall be met in healthcare facilities:Triggering the dispenser must be possible without using hands. Sensor- or elbow-operated dispensers both fulfill this requirement. Dispensers must be only refillable in a modality where the content, be it a hand rub or liquid soap, cannot be contaminated. This is achieved best by using replaceable cartridge systems. Refilling through "top-up" must not be possible. The disperser should allow usage of different types of cartridges made by different manufacturers. Dispensers must be operated and maintained such that a microbial contamination of the pump nozzle may easily be avoided. It must be possible to identify the products used in a dispenser easily and without any manipulation. Identifying the type of product, be it a hand rub or a liquid soap, as well as reading the product's name and critical manufacturers' warnings must be possible at any time. The disperser must allow identification of the level of the used product without any further manipulation at any time. The design of the dispenser must allow easy cleaning and disinfection the outside and inside of the dispenser. The manufacturer of the dispenser must provide the user with information on applicable chemicals and cleaning products. It must be possible to reprocess the dispenser and all of its permanent parts by applying machine based thermal disinfection at an A(0)-value of minimum 60 (e.g. 80°C/1 minute). Automatically portioning dispensers shall not fail during 200 hubs. The maximal allowed failure rate shall not exceed 1% (2 out of 200 consecutive hubs). A dispenser used for alcohol based hand rubs must allow keeping the alcohol concentration constant over a time period of 3 months. The maximum acceptable decrease in the concentration of the alcohol shall not exceed 5%. Liquid soap and hand rub dispensers with single-use pumps, ideally already mounted on the cartridge and to be discharged with the empty cartridge, are preferable. If pumps are used on the next consecutive cartridge, the manufacturer must provide the user with a detailed introduction for cleansing and reprocessing before further use. Because of forensic reasons it is recommended to place a good readable sign on the dispenser indicating e.g. "Apply alcohol based hand rubs only on the hand! Do not drink, avoid spraying into the eye or application on mucous membranes". It is regarded as an additional benefit, if the dispenser is able to document the consumption of hand rub or the frequency of hubs either mechanically or electronically.

Intervention studies on rational use of drugs in public and private sector in Nepal.

PubMed

Kafle, Kumud Kumar; Shrestha, Naveen; Karkee, Shiba Bahadur; Prasad, Radha Raman; Bhuju, Gajendra Bahadur; Das, Prabhakar Lal

2005-06-01

In developing countries, inappropriate, inefficient and ineffective use of pharmaceuticals have resulted into the poor health and medical cares for the community people. For improving the situation, various interventions have been tested and proved effective in different settings. In Nepal also, various strategies have been tested and found effective to improve the prescribing and dispensing practices. This paper has examined the process and results of different studies. The educational intervention, the training has not been effective in improving the prescribing practices but has limited effect on dispensing practices in the public sector. However, it becomes effective in improving prescribing practices if combined with a managerial intervention e.g. peer-group discussion. In private sector, training alone is effective in changing the drug recommendation practices of retailers. But none of interventions have been found to be effective in improving dispensing practices. After examining the effectiveness of different interventions, training combined with peer-group discussion is recommended for piloting in all Primary Health Care (PHC) outlets of a district to improve the prescribing practices. For improving the dispensing practices in both public and private sector, additional studies have to be carried out using different strategies.

Quantification of missing prescriptions in commercial claims databases: results of a cohort study.

PubMed

Cepeda, Maria Soledad; Fife, Daniel; Denarié, Michel; Bradford, Dan; Roy, Stephanie; Yuan, Yingli

2017-04-01

This study aims to quantify the magnitude of missed dispensings in commercial claims databases. A retrospective cohort study has been used linking PharMetrics, a commercial claims database, to a prescription database (LRx) that captures pharmacy dispensings independently of payment method, including cash transactions. We included adults with dispensings for opioids, diuretics, antiplatelet medications, or anticoagulants. To determine the degree of capture of dispensings, we calculated the number of subjects with the following: (1) same number of dispensings in both databases; (2) at least one dispensing, but not all dispensings, missed in PharMetrics; and (3) all dispensings missing in PharMetrics. Similar analyses were conducted using dispensings as the unit of analysis. To assess whether a dispensing in LRx was in PharMetrics, the dispensing in PharMetrics had to be for the same medication class and within ±7 days in LRx. A total of 1 426 498 subjects were included. Overall, 68% of subjects had the same number of dispensings in both databases. In 13% of subjects, PharMetrics identified ≥1 dispensing but also missed ≥1 dispensing. In 19% of the subjects, PharMetrics missed all the dispensings. Taking dispensings as the unit of analysis, 25% of the dispensings present in LRx were not captured in PharMetrics. These patterns were similar across all four classes of medications. Of the dispensings missing in PharMetrics, 48% involved a subject who had >1 health insurance plan. Commercial claims databases provide an incomplete picture of all prescriptions dispensed to patients. The lack of capture goes beyond cash transactions and potentially introduces substantial misclassification bias. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.

Analysis of costs to dispense prescriptions in independently owned, closed-door long-term care pharmacies.

PubMed

Carroll, Norman V; Rupp, Michael T; Holdford, David A

2014-03-01

The need for accurate calculation of long-term care (LTC) pharmacies' costs to dispense (CTD) has become more important as payers have moved toward reimbursement models based on pharmacies' actual acquisition cost for drug products and the Centers for Medicare Medicaid Services (CMS) has implemented requirements that LTC pharmacies must dispense prescriptions for certain branded drugs in 14-day-or-less quantities. To (a) calculate the average cost that the typical independently owned, closed-door LTC pharmacy currently incurs to dispense and deliver a prescription to the resident of a client LTC facility and (b) estimate how CMS-mandated changes to a 14-day-or-less dispensing cycle would affect the typical LTC pharmacy's average CTD. The data requirements and measurement model were developed by academic researchers in consultation with an industry advisory committee of independent LTC pharmacy owners. A survey instrument was constructed to collect financial and operating data required to calculate the CTD. Surveys were distributed via 3 dissemination channels to approximately 1,000 independently owned, closed-door LTC pharmacies. The National Community Pharmacists Association mailed surveys to their LTC members; 3 major national wholesalers distributed surveys to their LTC customers through their newsletters; and 3 LTC group purchasing organizations distributed the surveys to their members through emails, newsletters, mailings, and/or regional meetings. Each pharmacy's CTD was calculated by dividing total LTC dispensing-related 
costs by the total number of prescriptions dispensed. Dispensing-related costs included costs incurred to physically dispense and deliver prescriptions (e.g., dispensing pharmacists' and technicians' salaries and costs of medication containers) and costs incurred to support the dispensing function (e.g., salaries of delivery and medical records personnel). A model based on dispensing-related fixed, variable, and semivariable costs was developed to examine the impact of shorter dispensing cycles on LTC pharmacies' CTD. A prescription volume increase of 19% was assumed based on converting only solid oral branded drugs to short-cycle dispensing. A diverse sample of 64 closed-door LTC pharmacies returned usable surveys. Sales from dispensing to LTC facilities accounted for more than 98% of total sales. Respondents indicated that they currently dispensed 23% of total doses in 14-day-or-less cycles and 76% in 28-31 day cycles. Most pharmacies used automated medication packaging technology, heat and cold package sealers, bar code systems, sterile compounding hoods, LTC printers or labelers, and electronic prescribing. The median CTD was $13.54 with an interquartile range (25th to 75th percentiles) of $10.51 to $17.66. More than half of dispensing-related costs were from personnel expense, of which pharmacists and managers accounted for more than 40%. The results of the fixed and variable cost modeling suggested that converting solid oral brand-name drugs from 30-day to 14-day dispensing cycles would lower the median per prescription CTD to between $11.63 and $12.54, depending on the assumptions made about the effects of semivariable costs. However, this decrease in per prescription dispensing cost is dwarfed by an increase in total dispensing cost incurred by pharmacies that results from doubling the monthly volume of short-cycle prescriptions that must be dispensed. The result is that the typical LTC pharmacy in our sample incurred a CTD of $13.54 if the medication is dispensed in a 30-day cycle or $23.26 if the medication is dispensed in two 14-day cycles (at a cost of $11.63 for each cycle dispensed). Our results indicated a median CTD of $13.54 for the typical independently owned, closed-door LTC pharmacy. Moving to a shorter cycle would reduce pharmacies' average per-prescription CTD but would increase the number of prescriptions dispensed per month. Our results indicated that transitioning solid oral branded products to 14-day cycles would reduce the median CTD to a minimum of $11.63 but would increase total dispensing costs because each sold oral branded prescription would require twice the number of monthly dispensing events.

Prescription Opioid Use, Harms and Interventions in Canada: A Review Update of New Developments and Findings since 2010.

PubMed

Murphy, Yoko; Goldner, Elliot M; Fischer, Benedikt

2015-01-01

Canada has featured the second-highest levels of prescription opioid (PO) use globally behind the United States, and reported extensive PO-related harms (e.g., non-medical PO use [NMPOU], PO-related morbidity and mortality). A recent comprehensive review synthesized key data on PO use, PO-related harms, and interventions in Canada, yet a substantive extent of new studies and data have emerged. To conduct and present a comprehensive review update on PO use, PO-related harms, and interventions in Canada since 2010. Narrative review We conducted literature searches, employing pertinent keywords, in key databases, focusing on PO-related studies/data in/for Canada since 2010, or pertinent studies/data from earlier periods not included in our previous review. In addition, we identified relevant data from "grey" literature (e.g., government, survey, other data or system reports). Relevant data were screened and extracted, and categorized into 4 main sections of indicators: 1) PO dispensing and use, 2) non-medical PO use, 3) PO-related morbidity/mortality, 4) PO-related interventions and impacts. PO-dispensing in Canada overall continued to increase and/or remain at high levels in Canada from 2010 to 2013, with the exception of the province of Ontario where marked declines occurred starting in2012; quantitative and qualitative PO dispensing patterns continued to vary considerably between provinces. Several studies identified common "high PO dosing" prescribing practices in different settings. Various data suggested declining NMPOU levels throughout most general (e.g., adult, students), yet not in special risk (e.g., street drug users, First Nations) populations. While treatment demand in Ontario plateaued, rising PO-related driving risks as well as neo-natal morbidity were identified by different studies. PO-related mortality was measured to increase--in total numbers and proportionally--in various Canadian jurisdictions. Select reductions in general PO and/or high-dose PO dispensing were observed following key interventions (e.g., Oxycodone delisting, prescription monitoring program [PMP] introduction in Ontario/British Columbia). While physician education intervention studied indicated mixed outcomes, media reporting was found to be associated with PO prescribing patterns. The present review did not utilize systematic review standards or meta-analytic techniques given the large heterogeneity of data and outcomes reviewed. Recently emerging data help to better characterize PO-related use, harm and intervention indicators in Canada's general context of comparatively high-level PO dispensing and harms, yet major gaps in monitoring and information persist; this continues to be a problematic challenge, especially given the implementation of key PO-related interventions post-2010, the impact of which needs to be properly measured and understood.

Microbiological quality of drinking water from dispensers in roadside restaurants of Bangladesh.

PubMed

Moniruzzaman, M; Akter, S; Islam, M A; Mia, Z

2011-01-15

The microbiological status of water from dispensers in different roadside restaurants of Dhaka city and Savar area was analyzed in this study. Seven samples from Dhaka and 8 samples of Savar were checked. The heterotrophic plate count was in a range of 1.0 x 10(3) CFU mL(-1) to 2.0 x 10(4) CFU mL(-1) (from new bottles), 1.0 x 10(3) to 1.5 x 10(4) CFU mL(-1) (after dispensation), and 1.5 x 10(3) CFU mL(-1) to 1.0 x l0(5) CFU mL(-1) (from serving glass). In several of the samples, the heterotrophic plate count was higher than the count in water from new bottle or after dispensation, suggesting added contamination from the serving glass. 80% of the samples were contaminated with total and fecal coliform bacteria, which render these waters unacceptable for human consumption. The samples were found to contain gram negative bacteria like E coli, Shigella sp., Klebsiella sp., Enterobacter sp., Pseudomonas sp., and Salmonella sp., which are potential pathogens and thus pose a serious threat to public health. This study elucidates the importance of monitoring the bottling companies and the restaurants and put them under strict regulations to prevent future outbreak of any water borne diseases caused by consumption of dispensed water.

Effects of dispense equipment sequence on process start-up defects

NASA Astrophysics Data System (ADS)

Brakensiek, Nick; Sevegney, Michael

2013-03-01

Photofluid dispense systems within coater/developer tools have been designed with the intent to minimize cost of ownership to the end user. Waste and defect minimization, dispense quality and repeatability, and ease of use are all desired characteristics. One notable change within commercially available systems is the sequence in which process fluid encounters dispense pump and filtration elements. Traditionally, systems adopted a pump-first sequence, where fluid is "pushed through" a point-of-use filter just prior to dispensing on the wafer. Recently, systems configured in a pump-last scheme have become available, where fluid is "pulled through" the filter, into the pump, and then is subsequently dispensed. The present work constitutes a comparative evaluation of the two equipment sequences with regard to the aforementioned characteristics that impact cost of ownership. Additionally, removal rating and surface chemistry (i.e., hydrophilicity) of the point-of-use filter are varied in order to evaluate their influence on system start-up and defects.

Patients’ perception of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom

PubMed Central

2016-01-01

Objective: Patients’ opinion about prevalence of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom. The secondary objective was to identify appropriate action(s) to enhance patients’ awareness of pharmaceutical services in rural areas. Methods: A self-administered, anonymous questionnaire was distributed to patients visiting a community pharmacy in Eye, Suffolk, United Kingdom between July and August, 2015. The main inclusion criterion was living in a rural area. Comparisons were performed using chi-square tests and logistic regression. Results: The study included 103 respondents: 70 women (69.0%) and 33 men (32.0%), aged 16–85 years. Most respondents declared the primary tasks of a community pharmacy were dispensing medicines (86.4% of respondents) and repeat dispensing (72.8% of respondents). Additionally, 23.3% of respondents treated minor ailments at the pharmacy, including bacterial/viral infections, minor injuries, stomach problems, and allergies. The Medicines Use Review service was the only advanced service used in this pharmacy (12.6% of respondents), primarily by men. Younger patients were more familiar with the term of pharmaceutical care (p<0.05; OR=0.33). Conclusions: Only a few pharmaceutical services are utilized by people living in rural areas in the UK, namely prescription dispensing, repeat dispensing, and sale of medications that support self-care for minor ailments. We found an overall poor awareness of the expanded variety of pharmaceutical services encouraged by the community pharmacy contract introduced in the UK in 2005. Therefore, politicians, pharmacists, and pharmacy experts should actively promote these advanced pharmaceutical services in rural areas. PMID:27785163

Safe pill-dispensing.

PubMed

Testa, Massimiliano; Pollard, John

2007-01-01

Each patient is supplied with a smart-card containing a Radio Frequency IDentification (RFID) chip storing a unique identification code. The patient places the Smart-card on a pill-dispenser unit containing an RFID reader. The RFID chip is read and the code sent to a Base-station via a wireless Bluetooth link. A database containing both patient details and treatment information is queried at the Base-station using the RFID as the search key. The patient's treatment data (i.e., drug names, quantities, time, etc.) are retrieved and sent back to the pill-dispenser unit via Bluetooth. Appropriate quantities of the required medications are automatically dispensed, unless the patient has already taken his/her daily dose. Safe, confidential communication and operation is ensured.

Evaluation and remediation of bulk soap dispensers for biofilm.

PubMed

Lorenz, Lindsey A; Ramsay, Bradley D; Goeres, Darla M; Fields, Matthew W; Zapka, Carrie A; Macinga, David R

2012-01-01

Recent studies evaluating bulk soap in public restroom soap dispensers have demonstrated up to 25% of open refillable bulk-soap dispensers were contaminated with ~ 6 log(10)(CFU ml(-1)) heterotrophic bacteria. In this study, plastic counter-mounted, plastic wall-mounted and stainless steel wall-mounted dispensers were analyzed for suspended and biofilm bacteria using total cell and viable plate counts. Independent of dispenser type or construction material, the bulk soap was contaminated with 4-7 log(10)(CFU ml(-1)) bacteria, while 4-6 log(10)(CFU cm(-2)) biofilm bacteria were isolated from the inside surfaces of the dispensers (n = 6). Dispenser remediation studies, including a 10 min soak with 5000 mg l(-1) sodium hypochlorite, were then conducted to determine the efficacy of cleaning and disinfectant procedures against established biofilms. The testing showed that contamination of the bulk soap returned to pre-test levels within 7-14 days. These results demonstrate biofilm is present in contaminated bulk-soap dispensers and remediation studies to clean and sanitize the dispensers are temporary.

Combined approaches using sex pheromone and pear ester for behavioral disruption of codling moth (Lepidoptera: Tortricidae)

USDA-ARS?s Scientific Manuscript database

Studies utilized the attractive properties of pear ester, ethyl (E,Z)-2,4-decadienoate, and codlemone, (E,E)-8,10-dodecadien-1-ol, the sex pheromone of codling moth, Cydia pomonella (L)., for behavioural disruption. Standard dispensers loaded with codlemone alone or in combination with pear ester (c...

Alternative Fuels Data Center: Status Update: Ethanol Blender Pump

Science.gov Websites

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Shopping behavior for ADHD drugs: results of a cohort study in a pharmacy database.

PubMed

Cepeda, M Soledad; Fife, Daniel; Berwaerts, Joris; Yuan, Yingli; Mastrogiovanni, Greg

2014-09-01

Attention-deficit hyperactivity disorder (ADHD) medications are subject to abuse, misuse, and diversion. Obtaining ADHD prescriptions from multiple prescribers or filled across multiple pharmacies, known as 'doctor shopping', may reflect such unsanctioned use. We sought to create a definition of shopping behavior that differentiated ADHD medications from medications with low risk of diversion, i.e. asthma medications, and describe the incidence, frequency, and demography of shopping behavior. This was a retrospective cohort study in a pharmacy database-LRx-covering 65 % of US retail pharmacies. Subjects had ADHD or asthma medication dispensed between February 2011 and January 2012. We followed subjects for 18 months to assess the number with overlapping dispensings from different prescribers, and the number of prescribers and pharmacies involved in those dispensings. We included 4,402,464 subjects who were dispensed ADHD medications, and 6,128,025 subjects who were dispensed asthma medications. Overlapping prescriptions from two or more prescribers dispensed by three or more pharmacies was four times more frequent in the ADHD cohort than in the asthma cohort. Using this definition, ADHD medication shopping behavior was more common among experienced users than naïve users, and was most common in subjects aged 10-39 years. Among subjects who shopped, 57.4 % shopped only once (accounting for 22.4 % of episodes), and 9.2 % shopped six or more times (accounting for 42.0 % of episodes). Shoppers more often received stimulant ADHD drugs than non-stimulants. Overlapping prescriptions by different prescribers and filled at three or more pharmacies defines ADHD medication shopping. Shopping behavior is most common in adolescents and younger adults. A small proportion of shoppers is responsible for a large number of shopping episodes.

Electrically Controllable Microparticle Synthesis and Digital Microfluidic Manipulation by Electric-Field-Induced Droplet Dispensing into Immiscible Fluids

PubMed Central

Um, Taewoong; Hong, Jiwoo; Im, Do Jin; Lee, Sang Joon; Kang, In Seok

2016-01-01

The dispensing of tiny droplets is a basic and crucial process in a myriad of applications, such as DNA/protein microarray, cell cultures, chemical synthesis of microparticles, and digital microfluidics. This work systematically demonstrates droplet dispensing into immiscible fluids through electric charge concentration (ECC) method. It exhibits three main modes (i.e., attaching, uniform, and bursting modes) as a function of flow rates, applied voltages, and gap distances between the nozzle and the oil surface. Through a conventional nozzle with diameter of a few millimeters, charged droplets with volumes ranging from a few μL to a few tens of nL can be uniformly dispensed into the oil chamber without reduction in nozzle size. Based on the features of the proposed method (e.g., formation of droplets with controllable polarity and amount of electric charge in water and oil system), a simple and straightforward method is developed for microparticle synthesis, including preparation of colloidosomes and fabrication of Janus microparticles with anisotropic internal structures. Finally, a combined system consisting of ECC-induced droplet dispensing and electrophoresis of charged droplet (ECD)-driven manipulation systems is constructed. This integrated platform will provide increased utility and flexibility in microfluidic applications because a charged droplet can be delivered toward the intended position by programmable electric control. PMID:27534580

Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic non-cancer pain

PubMed Central

Ringwalt, Chris; Roberts, Andrew W.; Gugelmann, Hallam; Skinner, Asheley Cockrell

2016-01-01

Objective Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic non-cancer pain (CNCP) and the role of physician specialty. Design A retrospective cohort study. Setting We analyzed North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries dispensed prescriptions for opioids. Subjects The population included White and Black North Carolina Medicaid beneficiaries with CNCP (n=75,458). Methods We used bivariate statistics and logistic regression analysis to examine race-based discrepancies in opioid prescribing by physician specialty. Results Compared to White beneficiaries with CNCP (n=49,197), Black beneficiaries (n=26,261) were less likely [OR 0.91 (CI: 0.88–0.94)] to fill an opioid prescription. Our hypothesis was partially supported: we found that race-based differences in beneficiaries dispensed opioid prescriptions were more prominent in certain specialties. In particular, these differences were most salient among patients of specialists in obstetrics and gynecology [OR 0.78 (CI: 0.67–0.89)] and internal medicine [OR 0.86 (CI: 0.79–0.92)], as well as general practitioners/family medicine physicians [OR 0.91 (CI: 0.85–0.97)]. Conclusions Our findings suggest that, in our study population, Black beneficiaries with CNCP are less likely than Whites to fill prescriptions for opioid analgesics as a function of their provider’s specialty. Although race-based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty. PMID:25287703

Towards more reliable automated multi-dose dispensing: retrospective follow-up study on medication dose errors and product defects.

PubMed

Palttala, Iida; Heinämäki, Jyrki; Honkanen, Outi; Suominen, Risto; Antikainen, Osmo; Hirvonen, Jouni; Yliruusi, Jouko

2013-03-01

To date, little is known on applicability of different types of pharmaceutical dosage forms in an automated high-speed multi-dose dispensing process. The purpose of the present study was to identify and further investigate various process-induced and/or product-related limitations associated with multi-dose dispensing process. The rates of product defects and dose dispensing errors in automated multi-dose dispensing were retrospectively investigated during a 6-months follow-up period. The study was based on the analysis of process data of totally nine automated high-speed multi-dose dispensing systems. Special attention was paid to the dependence of multi-dose dispensing errors/product defects and pharmaceutical tablet properties (such as shape, dimensions, weight, scored lines, coatings, etc.) to profile the most suitable forms of tablets for automated dose dispensing systems. The relationship between the risk of errors in dose dispensing and tablet characteristics were visualized by creating a principal component analysis (PCA) model for the outcome of dispensed tablets. The two most common process-induced failures identified in the multi-dose dispensing are predisposal of tablet defects and unexpected product transitions in the medication cassette (dose dispensing error). The tablet defects are product-dependent failures, while the tablet transitions are dependent on automated multi-dose dispensing systems used. The occurrence of tablet defects is approximately twice as common as tablet transitions. Optimal tablet preparation for the high-speed multi-dose dispensing would be a round-shaped, relatively small/middle-sized, film-coated tablet without any scored line. Commercial tablet products can be profiled and classified based on their suitability to a high-speed multi-dose dispensing process.

The use of natural language processing on narrative medication schedules to compute average weekly dose.

PubMed

Lu, Chao-Chin; Leng, Jianwei; Cannon, Grant W; Zhou, Xi; Egger, Marlene; South, Brett; Burningham, Zach; Zeng, Qing; Sauer, Brian C

2016-12-01

Medications with non-standard dosing and unstandardized units of measurement make the estimation of prescribed dose difficult from pharmacy dispensing data. A natural language processing tool named the SIG extractor was developed to identify and extract elements from narrative medication instructions to compute average weekly doses (AWDs) for disease-modifying antirheumatic drugs. The goal of this paper is to evaluate the performance of the SIG extractor. This agreement study utilized Veterans Health Affairs pharmacy data from 2008 to 2012. The SIG extractor was designed to extract key elements from narrative medication schedules (SIGs) for 17 select medications to calculate AWD, and these medications were categorized by generic name and route of administration. The SIG extractor was evaluated against an annotator-derived reference standard for accuracy, which is the fraction of AWDs accurately computed. The overall accuracy was 89% [95% confidence interval (CI) 88%, 90%]. The accuracy was ≥85% for all medications and route combinations, except for cyclophosphamide (oral) and cyclosporine (oral), which were 79% (95%CI 72%, 85%) and 66% (95%CI 58%, 73%), respectively. The SIG extractor performed well on the majority of medications, indicating that AWD calculated by the SIG extractor can be used to improve estimation of AWD when dispensed quantity or days' supply is questionable or improbable. The working model for annotating SIGs and the SIG extractor are generalized and can easily be applied to other medications. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Pharmacists' role in opioid overdose: Kentucky pharmacists' willingness to participate in naloxone dispensing.

PubMed

Freeman, Patricia R; Goodin, Amie; Troske, SuZanne; Strahl, Audra; Fallin, Amanda; Green, Traci C

To assess pharmacists' willingness to initiate the dispensing of naloxone. As of 2015, Kentucky law permits certified pharmacists to dispense naloxone under a physician-approved protocol. Electronic survey (e-mail) gauging perception of pharmacists' role in opioid overdose and attitudes toward, and barriers to, naloxone dispensing. All Kentucky pharmacists with active licenses in 2015. Ordinal logistic regression was used to estimate the impact of pharmacist characteristics and attitudes on willingness to initiate naloxone dispensing, where the dependent variable was operationalized as a Likert-type question on a scale of 1 (not at all willing) to 6 (very willing). Of 4699 practicing Kentucky pharmacists, 1282 responded, of which 834 were community practitioners (response rate 27.3%). Pharmacists reported varying willingness to initiate naloxone dispensing, with 37.3% very willing (score 5 or 6) and 27.9% not willing (score 1 or 2). However, a majority of pharmacists reported willingness to dispense naloxone with a valid prescription (54.0%, score 5 or 6). Women pharmacists were 1.3 times more likely than men to be willing to initiate naloxone dispensing (95% confidence interval [CI] 1.0-1.6). Those who reported confidence in identifying individuals at risk for overdose were 1.2 times more likely to initiate dispensing, and those who reported confidence in ability to educate patients about overdose were 1.6 times more likely to express willingness to initiate naloxone dispensing (95% CIs, respectively, 1.0-1.3 and 1.4-1.8). Community pharmacists reported barriers to naloxone access at higher rates than pharmacists from other practice settings. Kentucky pharmacists are divided in their willingness to initiate naloxone dispensing; however, those who are confident in their ability to identify overdose risks are more willing. Increasing pharmacist confidence through appropriately designed education programs could facilitate pharmacist participation in naloxone dispensing. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Less and less-influence of volume on hand coverage and bactericidal efficacy in hand disinfection.

PubMed

Kampf, Günter; Ruselack, Sigunde; Eggerstedt, Sven; Nowak, Nicolas; Bashir, Muhammad

2013-10-10

Some manufacturers recommend using 1.1 mL per application of alcohol-based handrubs for effective hand disinfection. However, whether this volume is sufficient to cover both hands, as recommended by the World Health Organization, and fulfills current efficacy standards is unknown. This study aimed to determine hand coverage for three handrubs (two gels based on 70% v/v and 85% w/w ethanol and a foam based on 70% v/v ethanol) applied at various volumes. Products were tested at product volumes of 1.1 mL, 2 mL, 2.4 mL as well as 1 and 2 pump dispenser pushes; the foam product was tested in addition at foam volumes of 1.1 mL, 2 mL, and 2.4 mL. Products were supplemented with a fluorescent dye and 15 participants applied products using responsible application techniques without any specific steps but the aim of completely covering both hands. Coverage quality was determined under ultraviolet light by two blinded investigators. Efficacy of the three handrubs was determined according to ASTM E 1174-06 and ASTM E 2755-10. For each experiment, the hands of 12 participants were contaminated with Serratia marcescens and the products applied as recommended (1.1 mL for 70% v/v ethanol products; 2 mL for the 85% w/w ethanol product). Log10-reduction was calculated. Volumes < 2 mL yielded high rates of incomplete coverage (67%-87%) whereas volumes ≥ 2 mL gave lower rates (13%-53%). Differences in coverage were significant between the five volumes tested for all handrubs (p < 0.001; two-way ANOVA) but not between the three handrubs themselves (p = 0.796). Application of 1.1 mL of 70% v/v ethanol rubs reduced contamination by 1.85 log10 or 1.60 log10 (ASTM E 1174-06); this failed the US FDA efficacy requirement of at least 2 log10. Application of 2 mL of the 85% w/w ethanol rub reduced contamination by 2.06 log10 (ASTM E 1174-06), fulfilling the US FDA efficacy requirement. Similar results were obtained according to ASTM E 2755-10. Our data indicated that handrubs based on 70% ethanol (v/v) with a recommended volume of 1.1 mL per application do not ensure complete coverage of both hands and do not achieve current ASTM efficacy standards.

Discrepancies in medication entries between anesthetic and pharmacy records using electronic databases.

PubMed

Vigoda, Michael M; Gencorelli, Frank J; Lubarsky, David A

2007-10-01

Accurate recording of disposition of controlled substances is required by regulatory agencies. Linking anesthesia information management systems (AIMS) with medication dispensing systems may facilitate automated reconciliation of medication discrepancies. In this retrospective investigation at a large academic hospital, we reviewed 11,603 cases (spanning an 8-mo period) comparing records of medications (i.e., narcotics, benzodiazepines, ketamine, and thiopental) recorded as removed from our automated medication dispensing system with medications recorded as administered in our AIMS. In 15% of cases, we found discrepancies between dispensed versus administered medications. Discrepancies occurred in both the AIMS (8% cases) and the medication dispensing system (10% cases). Although there were many different types of user errors, nearly 75% of them resulted from either an error in the amount of drug waste documented in the medication dispensing system (35%); or an error in documenting the medication in the AIMS (40%). A significant percentage of cases contained data entry errors in both the automated dispensing and AIMS. This error rate limits the current practicality of automating the necessary reconciliation. An electronic interface between an AIMS and a medication dispensing system could alert users of medication entry errors prior to finalizing a case, thus reducing the time (and cost) of reconciling discrepancies.

A microfluidic distribution system for an array of hollow microneedles

NASA Astrophysics Data System (ADS)

Hoel, Antonin; Baron, Nolwenn; Cabodevila, Gonzalo; Jullien, Marie-Caroline

2008-06-01

We report a microfluidic device able to control the ejection of fluid through a matrix of out-of-plane microneedles. The device comprises a matrix of open dispensing units connected to needles and filled by a common filling system. A deformable membrane (e.g. in PDMS) is brought into contact with the dispensing units. Pressure exerted on the deformable membrane closes (and thus individualizes) each dispensing unit and provokes the ejection of the dispensing unit content through the outlets. Sufficient pressure over the deformable membrane ensures that all dispensing units deliver a fixed volume (their content) irrespective of the hydrodynamic pressure outside the dispensing unit outlet. The size of the ensemble matrix of dispensing units, the number of liquid reservoirs, as well as the material can vary depending on the considered application of the device or on the conditions of use. In the present paper, the liquid reservoirs are geometrically identical. The geometrical parameters of the device are optimized to avoid as much dead volume as possible, as it was to handle plasmid DNA solutions which are very expensive. The conception, the fabrication and the experimental results are described in this paper. Our prototype is conceived to inject in a uniform way 10 µl of drug through 100 microneedles distributed over 1 cm2.

Antidepressant poisoning deaths in New Zealand for 2001.

PubMed

Reith, David; Fountain, John; Tilyard, Murray; McDowell, Rebecca

2003-10-24

To compare the rates of death per volume of drug dispensed for antidepressants in New Zealand. Deaths from antidepressant poisonings were identified from the reports of coronial inquiries for New Zealand in 2001. Prescriptions for antidepressant medications were identified from the PharmHouse database from 1 January 2001 to 31 December 2001. The rates of deaths (95% CI) per prescription, tablet/capsule or defined daily dose were calculated for individual antidepressants and classes of antidepressant. There were 200 poisoning deaths recorded in the database for New Zealand in 2001. Antidepressants were involved in 41 deaths, and death was attributed to an antidepressant in 23 cases. There were 5.52 (95% CI 3.85-7.68) deaths per 100 000 prescriptions for tricyclic antidepressants (TCAs) and 2.51 (1.57-3.79) deaths per 100 000 prescriptions for selective serotonin reuptake inhibitors (SSRIs). There was marked variability in rates of death per volume of drug dispensed between individual antidepressants. SSRIs have lower rates of death per volume of drug dispensed than TCAs and there is also variation in these rates within these classes of drugs. Toxicity in overdose should be considered when prescribing antidepressants.

Trends in radiopharmaceutical dispensing in a regional nuclear pharmacy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Basmadjian, G.P.; Johnston, J.; Barker, K.

1982-11-01

Dispensing trends for radiopharmaceuticals at a regional nuclear pharmacy over a 51-month period were studied. dispensing records of a regional nuclear pharmacy were analyzed with a forecasting procedure that uses univariate time data to produce time trends and autoregressive models. The overall number of prescriptions increased from 3500 to 5500 per quarter. Radiopharmaceuticals used in nuclear cardiology studies increased from less than 0.1% to 17.5% of total prescriptions dispensed, while radiopharmaceuticals used for brain imaging showed a steady decline from 29% to 11% of total prescriptions dispensed. The demand for other radiopharmaceuticals increased in areas such as renal studies, bonemore » studies, lung studies, liver-function studies, and /sup 67/Ga tumor-uptake studies, and declined slightly for static liver studies. Changes in dispensing trends for radiopharmaceuticals will continue as the practice of nuclear medicine concentrates more on functional studies and as newer imaging techniques become used for other purposes.« less

Electrically Controllable Microparticle Synthesis and Digital Microfluidic Manipulation by Electric-Field-Induced Droplet Dispensing into Immiscible Fluids

NASA Astrophysics Data System (ADS)

Um, Taewoong; Hong, Jiwoo; Kang, In Seok

2016-11-01

The dispensing of tiny droplets is a basic and crucial process in a myriad of applications, such as DNA/protein microarray, cell cultures, chemical synthesis of microparticles, and digital microfluidics. This work demonstrates the droplet dispensing into immiscible fluids through electric charge concentration (ECC) method. Three main modes (i.e., attaching, uniform and bursting modes) are exhibited as a function of flow rates, applied voltage and gap distance between the nozzle and the oil surface. Through a conventional nozzle with diameter of a few millimeters, charged droplets with volumes ranging from a few μL to a few tens of nL can be uniformly dispensed into the oil chamber without reduction in nozzle size. Based on the features of the proposed method (e.g., formation of droplets with controllable polarity and amount of electric charge in water and oil system), a simple and straightforward method is developed for microparticle synthesis, including preparation for colloidosomes and fabrication of Janus microparticles with anisotropic internal structures. Finally, a combined system consisting of ECC-induced droplet dispensing and electrophoresis of charged droplet (ECD)-driven manipulation systems is constructed. This work was supported by the BK21Plus Program for advanced education of creative chemical engineers of the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP).

Factors affecting patients' knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan.

PubMed

Saqib, Anum; Atif, Muhammad; Ikram, Raazeyah; Riaz, Fatima; Abubakar, Muhammad; Scahill, Shane

2018-01-01

Patients' knowledge about their prescribed medicines is one of the most important antecedents of successful therapy. Poor knowledge about medicines can lead to serious consequences such as non-adherence and misunderstanding of the significance of adverse events. The objective of this study is to understand the factors that are responsible for a patients' lack of knowledge regarding their medicines, by taking the perspective of the patient as well as that of healthcare professionals. Much of the work in this area has been undertaken in the setting of developed or semi-developed countries, and there is a scarcity of information from developing nations such as Pakistan. This was a large qualitative study set in the hospital outpatient environment in a teaching hospital in the Punjab province of Pakistan. Data were collected from dialogue with patients (n = 19) and healthcare providers (n = 16) i.e., doctors and dispensers (where a dispenser is a person who merely dispenses medicines; i.e. is not a pharmacist) through in-depth semi-structured interviews. Patients having limited knowledge about their dispensed medicines were assessed using a checklist. The healthcare providers were recruited through a convenience sampling strategy, based on their availability and willingness to participate in the study. Based on the objectives of the study, a pilot tested interview protocol was developed, and used to conduct the interviews. The sample size was controlled by using saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis. The analysis of data yielded 31 categories (patients = 19, healthcare professionals = 12), 10 subthemes and three themes. The major themes were healthcare professional-related factors, patient-related factors and system-related factors. The health professional related subthemes included: behaviour and attitude and professional liabilities and liaison. The patient related subthemes included: eagerness of the patients and lack of understanding and misconception. The system-related factors included: patients with special needs, perceived role of the pharmacist, prescription and medicines, and staff workload. Healthcare professional related, patient related and system related factors have a significant influence on patients' knowledge about dispensed medicines. The non-professional behaviour of doctors, increased staff workload, inadequate time and attention provided by healthcare professionals to patients, illiteracy of patients, lack of specialized labelling on medicines for illiterate patients and absence of pharmacists at the hospital, were the major concerns identified in this study. The study points to a need for appropriate patient education and counselling with regards medicines, improved coordination between hospital staff, and provision of some basic system-related facilities which are pivotal for enhancing patients' knowledge and adherence to their treatment regimens.

The changing patterns of dispensing branded and generic drugs for the treatment of gastroesophageal reflux disease between 2006 and 2011 in Japan: a retrospective cohort study.

PubMed

Murata, Kyoko; Hinotsu, Shiro; Hamada, Shota; Ezoe, Yasumasa; Muto, Manabu; Kawakami, Koji

2015-02-27

Despite rising healthcare costs, generic drugs are less frequently dispensed in Japan compared with other developed countries. This study aimed to describe changes in dispensing of branded and generic drugs and to explore possible factors that promote the use of generic drugs. We conducted a retrospective cohort study using a Japanese medical and pharmacy claims database. All proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) with indications for gastroesophageal reflux disease (GERD) described on Japanese labels were included. Patterns of dispensing branded and generic drugs for the treatment of GERD between 2006 and 2011 were analyzed. Multivariate logistic regression was applied to investigate factors associated with receiving generic drugs. The study cohort included 14,590 patients (male: 50.2%, mean age: 43.1 years). Branded drugs for GERD were still frequently dispensed despite an increase in the share of generic drugs. Only 4.3% of patients who initially received branded drugs switched to generic drugs. The percentage of patients who received only generic drugs increased over time (6.5% to 22.1%). The frequency of generic drug dispensing was the highest in the setting where both prescription and dispensing were implemented in clinics (43.3%), while the lowest in the setting where both prescription and dispensing were implemented in hospitals (11.5%). Factors associated with receiving generic drugs included year of dispensing (adjusted OR 2.22, 95% CI 1.94 to 2.55 for 2009-11 v 2006-8), prescription and dispensing setting (OR 1.81, 95% CI 1.44 to 2.26 for prescription in hospitals and dispensing in community pharmacies; OR 2.21, 95% CI 1.80 to 2.72 for prescription in clinics and dispensing in community pharmacies; and OR 4.55, 95% CI 3.68 to 5.62 for prescription and dispensing in clinics v prescription and dispensing in hospitals) and H2RAs (OR 1.64, 95% CI 1.49 to 1.81 compared to PPIs). The share of generic drugs for the treatment of GERD increased over time although branded drugs for GERD were still dispensed frequently. The use of generic drugs for GERD was influenced not only by government policies but also by changes in treatment approach and the setting of prescription and dispensing.

Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists.

PubMed

Obreli-Neto, Paulo Roque; Pereira, Leonardo Régis Leira; Guidoni, Camilo Molino; de Oliveira Baldoni, André; Marusic, Srecko; de Lyra-Júnior, Divaldo Pereira; de Almeida, Kelsen Luis; Pazete, Ana Claudia Montolezi; do Nascimento, Janaina Dutra; Kos, Mitja; Girotto, Edmarlon; Cuman, Roberto Kenji Nakamura

2013-01-01

Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. To evaluate the COC dispensing practices of CPs in a developing country. A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21(®) (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients' medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., "do you smoke?" (n = 2) and "what is your age?" (n = 1). None of the CPs measured the patient's blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure.

Community pharmacy and mail order cost and utilization for 90-day maintenance medication prescriptions.

PubMed

Khandelwal, Nikhil; Duncan, Ian; Rubinstein, Elan; Ahmed, Tamim; Pegus, Cheryl

2012-04-01

Pharmacy benefit management (PBM) companies promote mail order programs that typically dispense 90-day quantities of maintenance medications, marketing this feature as a key cost containment strategy to address plan sponsors' rising prescription drug expenditures. In recent years, community pharmacies have introduced 90-day programs that provide similar cost advantages, while allowing these prescriptions to be dispensed at the same pharmacies that patients frequent for 30-day quantities. To compare utilization rates and corresponding costs associated with obtaining 90-day prescriptions at community and mail order pharmacies for payers that offer equivalent benefits in different 90-day dispensing channels. We performed a retrospective, cross-sectional investigation using pharmacy claims and eligibility data from employer group clients of a large PBM between January 2008 and September 2010. We excluded the following client types: government, third-party administrators, schools, hospitals, 340B (federal drug pricing), employers in Puerto Rico, and miscellaneous clients for which the PBM provided billing services (e.g., the pharmacy's loyalty card program members). All employer groups in the sample offered 90-day community pharmacy and mail order dispensing and received benefits management services, such as formulary management and mail order pharmacy, from the PBM. We further limited the sample to employer groups that offered equivalent benefits for community pharmacy and mail order, defined as groups in which the mean and median copayments per claim for community and mail order pharmacy, by tier, differed by no more than 5%. Enrollees in the sample were required to have a minimum of 6 months of eligibility in each calendar year but were not required to have filled a prescription in any year. We evaluated pharmacy costs and utilization for a market basket of 14 frequently dispensed therapeutic classes of maintenance medications. The proportional share of claims for each therapeutic class in the mail order channel was used to weight the results for the community pharmacy channel. Using ordinary least squares regression models, we controlled for differences between channel users with respect to the following confounding factors: age, gender, presence or absence of each of the top 11 drug-inferred conditions (e.g., asthma/chronic obstructive pulmonary disease, cardiovascular disease), drug mix, and calendar year. We calculated estimated predicted means holding all covariates at their mean values. For both 90-day dispensing channels, we calculated number of 90-day claims per member per year (PMPY) and cost per pharmacy claim, with all claims counts adjusted to 30-day equivalents (i.e., number of 90-day claims × 3). Differences were compared using t-tests for statistical significance. Of 355 PBM clients prior to exclusions, 72 unique employers covering 644,071 unique members (range of approximately 100 to more than 100,000 members per employer) were included in the analysis. On an unadjusted basis, community pharmacies represented 80.8% of 90-day market basket claims (in 30-day equivalents: 3.97 claims PMPY vs. 0.95 in mail order) and 77.2% of total allowed charges. After adjustments for therapeutic group mix and patient characteristics, predicted mean pharmacy claim counts PMPY were 4.09 for community pharmacy compared with 0.85 for mail order (P  less than  0.001). Predicted mean allowed charges per claim for community and mail order pharmacies did not significantly differ ($49.03 vs. $50.04, respectively, P = 0.202). When offered maintenance medications through community and mail order pharmacies on a benefit-equivalent basis, commercially insured employees and their dependents utilized the community pharmacy channel more frequently by a margin of more than 4 to 1 in terms of claims PMPY. Overall allowed charges per claim for community and mail order pharmacy did not significantly differ.

Assessing the performance, practices and roles of drug sellers/dispensers and mothers'/guardians' behaviour for common childhood conditions in Kibaha district, Tanzania.

PubMed

Nsimba, S E D

2007-10-01

In most third world countries, self-medication is common and pharmacies, drug stores and drug shops are important providers of health advice and inexpensive medicines. We used exit interviews to assess drug sellers'/dispensers' roles and consumers' behaviour in Kibaha district, Coast region, Tanzania. Exit interviews with mothers/guardians reported the following childhood conditions treated with or without prescriptions at drug shops: respiratory infections (34%), fever (21%), a combination of diarrhoea, acute respiratory infection (ARI) and fever (14%), diarrhoea alone (13%) and other conditions (17%). The majority of drug sellers/dispensers prescribed or dispensed branded drugs (85%) for most mothers/guardians who visited these drug shops. In addition, antibiotics in total were prescribed for 31% of the mothers/guardians. Of the antibiotics dispensed, 38% were not prescribed by clinicians. In total, oral rehydration salts (ORSs) (3%), antimalarials (sulphadoxine/pyrimethamine) (24%) and antipyretics (11%), were prescribed in 20% but were bought by only 9%; multivitamins (6%), cough mixtures (4%) and other drugs (2%) (antihelminthics, benzylbenzoate emulsions, ear and eye drops) were also purchased from these facilities. Of the diarrhoea case histories presented by simulated clients at the drug shops, only 35% of the bloody diarrhoea scenarios were accurately diagnosed for getting antibiotics as compared with 44% for watery diarrhoea for which the use of antibiotics were wrongly advised (P<0.01). Furthermore, drug sellers/dispensers in these drug shops recommended use of ORS less frequently (3%) for a combination of diarrhoea, ARI and fever, and 2% for ARI alone than for watery (29%) and bloody diarrhoea (32%), respectively, for children under five years of age (P<0.001). Antimicrobial agents were advised for ARI (38%), watery diarrhoea (44%) and bloody diarrhoea (35%), respectively, with no significant difference among the three common childhood conditions. Antipyretics were advised in almost all childhood conditions but were least in watery (2%) and bloody diarrhoea (4%). This study demonstrates that antibiotics are overused in both the urban and rural settings of Kibaha district and that this is due to both clinicians'and drug sellers'prescribing practices in public and private facilities. The use of branded drugs was more common than that of generic drugs in private pharmacies, drug stores and ordinary shops. It is hereby proposed that any intervention should focus on training both facilities in the district on selectively prescribing and rational use of antibiotics for ARI and diarrhoea, and also to prescribe and dispense generic drugs so that it costs patients less when they buy drugs in shops. There is a need to increase awareness in recommending the use of ORS for clients to manage watery and bloody diarrhoea, and ARI in children under five years of age.

Fast and direct screening of copper in micro-volumes of distilled alcoholic beverages by high-resolution continuum source graphite furnace atomic absorption spectrometry.

PubMed

Ajtony, Zsolt; Laczai, Nikoletta; Dravecz, Gabriella; Szoboszlai, Norbert; Marosi, Áron; Marlok, Bence; Streli, Christina; Bencs, László

2016-12-15

HR-CS-GFAAS methods were developed for the fast determination of Cu in domestic and commercially available Hungarian distilled alcoholic beverages (called pálinka), in order to decide if their Cu content exceeds the permissible limit, as legislated by the WHO. Some microliters of samples were directly dispensed into the atomizer. Graphite furnace heating programs, effects/amounts of the Pd modifier, alternative wavelengths (e.g., Cu I 249.2146nm), external calibration and internal standardization methods were studied. Applying a fast graphite furnace heating program without any chemical modifier, the Cu content of a sample could be quantitated within 1.5min. The detection limit of the method is 0.03mg/L. Calibration curves are linear up to 10-15mg/L Cu. Spike-recoveries ranged from 89% to 119% with an average of 100.9±8.5%. Internal calibration could be applied with the assistance of Cr, Fe, and/or Rh standards. The accuracy of the GFAAS results was verified by TXRF analyses. Copyright © 2016 Elsevier Ltd. All rights reserved.

Indicators related to the rational use of medicines and its associated factors

PubMed Central

Lima, Marina Guimarães; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units. METHOD This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators. RESULTS At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process. CONCLUSION The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services. PMID:29160461

Workforce in the pharmaceutical services of the primary health care of SUS, Brazil

PubMed Central

Carvalho, Marselle Nobre; Álvares, Juliana; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Karnikowski, Margô Gomes de Oliveira; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To characterize the workforce in the pharmaceutical services in the primary care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional and quantitative study, with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). For the analysis, we considered the data stratification into geographical regions. We analyzed the data on workers in the municipal pharmaceutical services management and in the medicine dispensing units, according to the country’s regions. For the statistical association analysis, we carried out a Pearson correlation test for the categorical variables. RESULTS We analyzed 1,175 pharmacies/dispensing units, 507 phone interviews (495 pharmaceutical services coordinators), and 1,139 professionals responsible for medicine delivery. The workforce in pharmaceutical services was mostly constituted by women, aged from 18 to 39 years, with higher education (90.7% in coordination and 45.5% in dispensing units), having permanent employment bonds (public tender), being for more than one year in the position or duty, and with weekly work hours above 30h, working both in municipal management and in medicine dispensing units. We observed regional differences in the workforce composition in dispensing units, with higher percentage of pharmacists in the Southeast and Midwest regions. CONCLUSIONS The professionalization of municipal management posts in primary health care is an achievement in the organization of the workforce in pharmaceutical services. However, significant deficiencies exist in the workforce composition in medicine dispensing units, which may compromise the medicine use quality and its results in population health. PMID:29160455

Potential drug-drug interactions between anti-cancer agents and community pharmacy dispensed drugs.

PubMed

Voll, Marsha L; Yap, Kim D; Terpstra, Wim E; Crul, Mirjam

2010-10-01

To identify the prevalence of potential drug-drug interactions between hospital pharmacy dispensed anti-cancer agents and community pharmacy dispensed drugs. A retrospective cohort study was conducted on the haematology/oncology department of the internal medicine ward in a large teaching hospital in Amsterdam, the Netherlands. Prescription data from the last 100 patients treated with anti-cancer agents were obtained from Paracelsus, the chemotherapy prescribing system in the hospital. The community pharmacy dispensed drugs of these patients were obtained by using OZIS, a system that allows regionally linked pharmacies to call up active medication on any patient. Both medication lists were manually screened for potential drug-drug interactions by using several information sources on interactions, e.g. Pubmed, the Flockhart P450 table, Micromedex and Dutch reference books. Prevalence of potential drug-drug interactions between anti-cancer agents provided by the hospital pharmacy and drugs dispensed by the community pharmacy. Ninety-one patients were included in the study. A total of 31 potential drug-drug interactions were found in 16 patients, of which 15 interactions were clinically relevant and would have required an intervention. Of these interactions 1 had a level of severity ≥ D, meaning the potential drug-drug interaction could lead to long lasting or permanent damage, or even death. The majority of the interactions requiring an intervention (67%) had a considerable level of evidence (≥ 2) and were based on well-documented case reports or controlled interaction studies. Most of the potential drug-drug interactions involved the antiretroviral drugs (40%), proton pump inhibitors (20%) and antibiotics (20%). The anti-cancer drug most involved in the drug-drug interactions is methotrexate (33%). This study reveals a high prevalence of potential drug-drug interactions between anti-cancer agents provided by the hospital pharmacy and drugs dispensed by the community pharmacy. It shows us there is need for an optimal medication surveillance mechanism to detect potential drug-drug interactions between these two groups of medication, especially because of the high toxicity of anticancer drugs and thus the severe consequences these interactions can have for the patient.

Documentation of study medication dispensing in a prospective large randomized clinical trial: experiences from the ARISTOTLE Trial.

PubMed

Alexander, John H; Levy, Elliott; Lawrence, Jack; Hanna, Michael; Waclawski, Anthony P; Wang, Junyuan; Califf, Robert M; Wallentin, Lars; Granger, Christopher B

2013-09-01

In ARISTOTLE, apixaban resulted in a 21% reduction in stroke, a 31% reduction in major bleeding, and an 11% reduction in death. However, approval of apixaban was delayed to investigate a statement in the clinical study report that "7.3% of subjects in the apixaban group and 1.2% of subjects in the warfarin group received, at some point during the study, a container of the wrong type." Rates of study medication dispensing error were characterized through reviews of study medication container tear-off labels in 6,520 participants from randomly selected study sites. The potential effect of dispensing errors on study outcomes was statistically simulated in sensitivity analyses in the overall population. The rate of medication dispensing error resulting in treatment error was 0.04%. Rates of participants receiving at least 1 incorrect container were 1.04% (34/3,273) in the apixaban group and 0.77% (25/3,247) in the warfarin group. Most of the originally reported errors were data entry errors in which the correct medication container was dispensed but the wrong container number was entered into the case report form. Sensitivity simulations in the overall trial population showed no meaningful effect of medication dispensing error on the main efficacy and safety outcomes. Rates of medication dispensing error were low and balanced between treatment groups. The initially reported dispensing error rate was the result of data recording and data management errors and not true medication dispensing errors. These analyses confirm the previously reported results of ARISTOTLE. © 2013.

Varying intervals of antiretroviral medication dispensing to improve outcomes for HIV patients (The INTERVAL Study): study protocol for a randomized controlled trial.

PubMed

Hoffman, Risa; Bardon, Ashley; Rosen, Sydney; Fox, Matthew; Kalua, Thoko; Xulu, Thembi; Taylor, Angela; Sanne, Ian

2017-10-13

Requirements for frequent dispensing of antiretroviral therapy (ART) place demands on health systems and can lead to suboptimal adherence and disengagement in care for patients due to the time and cost of frequent clinic visits. Rigorous data are needed to define optimal ART dispensing strategies and to evaluate the impact of a longer medication supply on retention and virologic suppression and determine whether this strategy lowers costs for both the patient and the health system. To date, no randomized studies have tested the benefits of 6-month dispensing of ART compared to 3-month and standard of care approaches. This study will be an unblinded cluster-randomized, matched controlled trial conducted among 8200 stable, HIV-infected individuals age 18 years and older on ART in Malawi and Zambia, to compare three ART dispensing intervals on the outcomes of retention in care (primary outcome), virologic suppression, and cost-effectiveness. Thirty clusters will be matched according to country, facility type, and ART cohort size and randomized to one of three study arms: standard of care, 3-month dispensing, and 6-month dispensing. Study participants will be followed, and outcomes will be measured at 12, 24, and 36 months. A subset of participants (n = 240) and providers (n = 180) will also participate in qualitative interviews to evaluate feasibility and acceptability of different ART dispensing intervals. This study will be the first to compare 6-month and 3-month ART dispensing intervals for stable, HIV-infected individuals in Malawi and Zambia. We focus on outcomes relevant to country programs, including retention, virologic suppression, and cost-effectiveness. Results from the study will help resource-limited health systems better understand the full scope of outcomes resulting from various ART dispensing intervals and help to inform health policy decisions. ClinicalTrials.gov, NCT03101592 . Registered on 18 March 2017. Pan African Clinical Trials, PACTR201706002336105 . Registered on 2 June 2017.

SIMulation of Medication Error induced by Clinical Trial drug labeling: the SIMME-CT study.

PubMed

Dollinger, Cecile; Schwiertz, Vérane; Sarfati, Laura; Gourc-Berthod, Chloé; Guédat, Marie-Gabrielle; Alloux, Céline; Vantard, Nicolas; Gauthier, Noémie; He, Sophie; Kiouris, Elena; Caffin, Anne-Gaelle; Bernard, Delphine; Ranchon, Florence; Rioufol, Catherine

2016-06-01

To assess the impact of investigational drug labels on the risk of medication error in drug dispensing. A simulation-based learning program focusing on investigational drug dispensing was conducted. The study was undertaken in an Investigational Drugs Dispensing Unit of a University Hospital of Lyon, France. Sixty-three pharmacy workers (pharmacists, residents, technicians or students) were enrolled. Ten risk factors were selected concerning label information or the risk of confusion with another clinical trial. Each risk factor was scored independently out of 5: the higher the score, the greater the risk of error. From 400 labels analyzed, two groups were selected for the dispensing simulation: 27 labels with high risk (score ≥3) and 27 with low risk (score ≤2). Each question in the learning program was displayed as a simulated clinical trial prescription. Medication error was defined as at least one erroneous answer (i.e. error in drug dispensing). For each question, response times were collected. High-risk investigational drug labels correlated with medication error and slower response time. Error rates were significantly 5.5-fold higher for high-risk series. Error frequency was not significantly affected by occupational category or experience in clinical trials. SIMME-CT is the first simulation-based learning tool to focus on investigational drug labels as a risk factor for medication error. SIMME-CT was also used as a training tool for staff involved in clinical research, to develop medication error risk awareness and to validate competence in continuing medical education. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Implementation of information systems at pharmacies - a case study from the re-regulated pharmacy market in Sweden.

PubMed

Hammar, Tora; Ohlson, Mats; Hanson, Elizabeth; Petersson, Göran

2015-01-01

When the Swedish pharmacy market was re-regulated in 2009, Sweden moved from one state-owned pharmacy chain to several private pharmacy companies, and four new dispensing systems emerged to replace the one system that had previously been used at all Swedish pharmacies for more than 20 years. The aim of this case study was to explore the implementation of the new information systems for dispensing at pharmacies. The vendors of the four dispensing systems in Sweden were interviewed, and a questionnaire was sent to the managers of the pharmacy companies. In addition, a questionnaire was sent to 350 pharmacists who used the systems for dispensing prescriptions. The implementation of four new dispensing systems followed a strict time frame set by political decisions, involved actors completely new to the market, lacked clear regulation and standards for functionality and quality assurance, was complex and resulted in variations in quality. More than half of the pharmacists (58%) perceived their current dispensing system as supporting safe dispensing of medications, 26% were neutral and 15% did not perceive it to support a safe dispensing. Most pharmacists (80%) had experienced problems with their dispensing system during the previous month. The pharmacists experienced problems included reliability issues, usability issues, and missing functionality. In this case study exploring the implementation of new information systems for dispensing prescriptions at pharmacies in Sweden, weaknesses related to reliability, functionality and usability were identified and could affect patient safety. The weaknesses of the systems seem to result from the limited time for the development and implementation, the lack of comprehensive and evidence-based requirements for dispensing systems, and the unclear distribution of quality assurance responsibilities among involved stakeholders. Copyright © 2015 Elsevier Inc. All rights reserved.

Conspicuous vs customary location of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit.

PubMed

Thomas, Bruce W; Berg-Copas, Gina M; Vasquez, Donald G; Jackson, Brandy L; Wetta-Hall, Ruth

2009-05-01

Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities. To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume. This prospective, observational study conducted in an intensive care unit was composed of three observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers). Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a statistically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196). More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.

Less and less–influence of volume on hand coverage and bactericidal efficacy in hand disinfection

PubMed Central

2013-01-01

Background Some manufacturers recommend using 1.1 mL per application of alcohol-based handrubs for effective hand disinfection. However, whether this volume is sufficient to cover both hands, as recommended by the World Health Organization, and fulfills current efficacy standards is unknown. This study aimed to determine hand coverage for three handrubs (two gels based on 70% v/v and 85% w/w ethanol and a foam based on 70% v/v ethanol) applied at various volumes. Methods Products were tested at product volumes of 1.1 mL, 2 mL, 2.4 mL as well as 1 and 2 pump dispenser pushes; the foam product was tested in addition at foam volumes of 1.1 mL, 2 mL, and 2.4 mL. Products were supplemented with a fluorescent dye and 15 participants applied products using responsible application techniques without any specific steps but the aim of completely covering both hands. Coverage quality was determined under ultraviolet light by two blinded investigators. Efficacy of the three handrubs was determined according to ASTM E 1174-06 and ASTM E 2755-10. For each experiment, the hands of 12 participants were contaminated with Serratia marcescens and the products applied as recommended (1.1 mL for 70% v/v ethanol products; 2 mL for the 85% w/w ethanol product). Log10-reduction was calculated. Results Volumes < 2 mL yielded high rates of incomplete coverage (67%–87%) whereas volumes ≥ 2 mL gave lower rates (13%–53%). Differences in coverage were significant between the five volumes tested for all handrubs (p < 0.001; two-way ANOVA) but not between the three handrubs themselves (p = 0.796). Application of 1.1 mL of 70% v/v ethanol rubs reduced contamination by 1.85 log10 or 1.60 log10 (ASTM E 1174-06); this failed the US FDA efficacy requirement of at least 2 log10. Application of 2 mL of the 85% w/w ethanol rub reduced contamination by 2.06 log10 (ASTM E 1174-06), fulfilling the US FDA efficacy requirement. Similar results were obtained according to ASTM E 2755-10. Conclusions Our data indicated that handrubs based on 70% ethanol (v/v) with a recommended volume of 1.1 mL per application do not ensure complete coverage of both hands and do not achieve current ASTM efficacy standards. PMID:24112994

Validating hospital antibiotic purchasing data as a metric of inpatient antibiotic use.

PubMed

Tan, Charlie; Ritchie, Michael; Alldred, Jason; Daneman, Nick

2016-02-01

Antibiotic purchasing data are a widely used, but unsubstantiated, measure of antibiotic consumption. To validate this source, we compared purchasing data from hospitals and external medical databases with patient-level dispensing data. Antibiotic purchasing and dispensing data from internal hospital records and purchasing data from IMS Health were obtained for two hospitals between May 2013 and April 2015. Internal purchasing data were validated against dispensing data, and IMS data were compared with both internal metrics. Scatterplots of individual antimicrobial data points were generated; Pearson's correlation and linear regression coefficients were computed. A secondary analysis re-examined these correlations over shorter calendar periods. Internal purchasing data were strongly correlated with dispensing data, with correlation coefficients of 0.90 (95% CI = 0.83-0.95) and 0.98 (95% CI = 0.95-0.99) at hospitals A and B, respectively. Although dispensing data were consistently lower than purchasing data, this was attributed to a single antibiotic at both hospitals. IMS data were favourably correlated with, but underestimated, internal purchasing and dispensing data. This difference was accounted for by eight antibiotics for which direct sales from some manufacturers were not included in the IMS database. The correlation between purchasing and dispensing data was consistent across periods as short as 3 months, but not at monthly intervals. Both internal and external antibiotic purchasing data are strongly correlated with dispensing data. If outliers are accounted for appropriately, internal purchasing data could be used for cost-effective evaluation of antimicrobial stewardship programmes, and external data sets could be used for surveillance and research across geographical regions. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Drug dispensing practices at pharmacies in Bengaluru: A cross-sectional study

PubMed Central

Soumya, R.; Devarashetty, Vijayalakshmi; Jayanthi, C. R.; Sushma, M.

2016-01-01

Objectives: Pharmacists are one of the crucial focal points for health care in the community. They have tremendous outreach to the public as pharmacies are often the first-port-of-call. With the increase of ready-to-use drugs, the main health-related activity of a pharmacist today is to assure the quality of dispensing, a key element to promote rational medicine use. Materials and Methods: A cross-sectional study of 200 pharmacies, 100 each in various residential (R) and commercial (C) areas of Bengaluru, was conducted using a prevalidated questionnaire administered to the chief pharmacist or the person-in-charge by the investigators. Results: Dispensing without prescription at pharmacies was 45% of the total dispensing encounters and significantly higher (χ2 = 15.2, P < 0.001, df = 1) in pharmacies of residential areas (46.64%) as compared to commercial areas (43.64%). Analgesics were the most commonly dispensed drugs (90%) without prescription. Only 31% insisted on dispensing full course of antibiotics prescribed and 19% checked for completeness of prescription before dispensing. Although 97% of the pharmacies had a refrigerator, 31% of these did not have power back-up. Only about 50% of the pharmacists were aware of Schedule H. Conclusion: This study shows a high proportion of dispensing encounters without prescription, a higher rate of older prescription refills, many irregularities in medication counseling and unsatisfactory storage practices. It also revealed that about half of the pharmacists were unaware of Schedule H and majority of them about current regulations. Hence, regulatory enforcement and educational campaigns are a prerequisite to improve dispenser's knowledge and dispensing practices. PMID:27756944

Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study.

PubMed

Saxena, Pikee; Mishra, Archana; Nigam, Aruna

2016-01-01

Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.

The impact of automation on workload and dispensing errors in a hospital pharmacy.

PubMed

James, K Lynette; Barlow, Dave; Bithell, Anne; Hiom, Sarah; Lord, Sue; Pollard, Mike; Roberts, Dave; Way, Cheryl; Whittlesea, Cate

2013-04-01

To determine the effect of installing an original-pack automated dispensing system (ADS) on dispensary workload and prevented dispensing incidents in a hospital pharmacy. Data on dispensary workload and prevented dispensing incidents, defined as dispensing errors detected and reported before medication had left the pharmacy, were collected over 6 weeks at a National Health Service hospital in Wales before and after the installation of an ADS. Workload was measured by non-participant observation using the event recording technique. Prevented dispensing incidents were self-reported by pharmacy staff on standardised forms. Median workloads (measured as items dispensed/person/hour) were compared using Mann-Whitney U tests and rate of prevented dispensing incidents were compared using Chi-square test. Spearman's rank correlation was used to examine the association between workload and prevented dispensing incidents. A P value of ≤0.05 was considered statistically significant. Median dispensary workload was significantly lower pre-automation (9.20 items/person/h) compared to post-automation (13.17 items/person/h, P < 0.001). Rate of prevented dispensing incidents was significantly lower post-automation (0.28%) than pre-automation (0.64%, P < 0.0001) but there was no difference (P = 0.277) between the types of dispensing incidents. A positive association existed between workload and prevented dispensing incidents both pre- (ρ = 0.13, P = 0.015) and post-automation (ρ = 0.23, P < 0.001). Dispensing incidents were found to occur during prolonged periods of moderate workload or after a busy period. Study findings suggest that automation improves dispensing efficiency and reduces the rate of prevented dispensing incidents. It is proposed that prevented dispensing incidents frequently occurred during periods of high workload due to involuntary automaticity. Prevented dispensing incidents occurring after a busy period were attributed to staff experiencing fatigue after-effects. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study

PubMed Central

Silva, Maria das Dores Graciano; Rosa, Mário Borges; Franklin, Bryony Dean; Reis, Adriano Max Moreira; Anchieta, Lêni Márcia; Mota, Joaquim Antônio César

2011-01-01

OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6%) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4%) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system. PMID:22012039

Making the case for change: What researchers need to consider when designing behavior change interventions aimed at improving medication dispensing.

PubMed

Cadogan, Cathal A; Ryan, Cristín; Hughes, Carmel

2016-01-01

There is a growing emphasis on behavior change in intervention development programmes aimed at improving public health and healthcare professionals' practice. A number of frameworks and methodological tools have been established to assist researchers in developing interventions seeking to change healthcare professionals' behaviors. The key features of behavior change intervention design involve specifying the target group (i.e. healthcare professional or patient cohort), the target behavior and identifying mediators (i.e. barriers and facilitators) of behavior change. Once the target behavior is clearly specified and understood, specific behavior change techniques can then be used as the basis of the intervention to target identified mediators of behavior change. This commentary outlines the challenges for pharmacy practice-based researchers in targeting dispensing as a behavior when developing behavior change interventions aimed at pharmacists and proposes a definition of dispensing to consider in future research. Copyright © 2016 Elsevier Inc. All rights reserved.

Understanding the Role of Accredited Drug Dispensing Outlets in Tanzania's Health System.

PubMed

Embrey, Martha; Vialle-Valentin, Catherine; Dillip, Angel; Kihiyo, Bernard; Mbwasi, Romuald; Semali, Innocent A; Chalker, John C; Liana, Jafary; Lieber, Rachel; Johnson, Keith; Rutta, Edmund; Kimatta, Suleiman; Shekalaghe, Elizabeth; Valimba, Richard; Ross-Degnan, Dennis

2016-01-01

People in many low-income countries access medicines from retail drug shops. In Tanzania, a public-private partnership launched in 2003 used an accreditation approach to improve access to quality medicines and pharmaceutical services in underserved areas. The government scaled up the accredited drug dispensing outlet (ADDO) program nationally, with over 9,000 shops now accredited. This study assessed the relationships between community members and their sources of health care and medicines, particularly antimicrobials, with a specific focus on the role ADDOs play in the health care system. Using mixed methods, we collected data in four regions. We surveyed 1,185 households and audited 96 ADDOs and 84 public/nongovernmental health facilities using a list of 17 tracer drugs. To determine practices in health facilities, we interviewed 1,365 exiting patients. To assess dispensing practices, mystery shoppers visited 306 ADDOs presenting one of three scenarios (102 each) about a child's respiratory symptoms. Of 614 household members with a recent acute illness, 73% sought outside care-30% at a public facility and 31% at an ADDO. However, people bought medicines more often at ADDOs no matter who recommended the treatment; of the 581 medicines that people had received, 49% came from an ADDO. Although health facilities and ADDOs had similar availability of antimicrobials, ADDOs had more pediatric formulations available (p<0.001). The common perception was that drugs from ADDOs are more expensive, but the difference in the median cost to treat pneumonia was relatively minimal (US$0.26 in a public facility and US$0.30 in an ADDO). Over 20% of households said they had someone with a chronic condition, with 93% taking medication, but ADDOs are allowed to sell very few chronic care-related medicines. ADDO dispensers are trained to refer complicated cases to a health facility, and notably, 99% of mystery shoppers presenting a pneumonia scenario received an antimicrobial (54%), a referral (90%), or both (45%), which are recommended practices for managing pediatric pneumonia. However, one-third of the dispensers needlessly sold antibiotics for cold symptoms, and 85% sold an antibiotic on request. In addition, the pneumonia scenario elicited more advice on handling the illness than the cold symptoms scenario (61% vs. 15%; p<0.0001), but overall, only 44% of the dispensers asked any of the shoppers about danger signs potentially associated with pneumonia in a child. ADDOs are the principal source of medicines in Tanzania and an important part of a multi-faceted health care system. Poor prescribing in health facilities, poor dispensing at ADDOs, and inappropriate patient demand continue to contribute to inappropriate medicines use. Therefore, while accreditation has attempted to address the quality of pharmaceutical services in private sector drug outlets, efforts to improve access to and use of medicines in Tanzania need to target ADDOs, public/nongovernmental health facilities, and the public to be effective.

Use of Simulated Patients to Evaluate Combined Oral Contraceptive Dispensing Practices of Community Pharmacists

PubMed Central

Obreli-Neto, Paulo Roque; Pereira, Leonardo Régis Leira; Guidoni, Camilo Molino; Baldoni, André de Oliveira; Marusic, Srecko; de Lyra-Júnior, Divaldo Pereira; de Almeida, Kelsen Luis; Pazete, Ana Claudia Montolezi; do Nascimento, Janaina Dutra; Kos, Mitja; Girotto, Edmarlon; Cuman, Roberto Kenji Nakamura

2013-01-01

Background Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. Objective To evaluate the COC dispensing practices of CPs in a developing country. Method A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21® (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients’ medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. Results Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., “do you smoke?” (n = 2) and “what is your age?” (n = 1). None of the CPs measured the patient’s blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. Conclusion The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure. PMID:24324584

Baseline job satisfaction and stress among pharmacists and pharmacy technicians participating in the Fleetwood Phase III Study.

PubMed

Lapane, Kate L; Hughes, Carmel M

2004-11-01

To provide baseline levels of job satisfaction and stress among members of the long-term care pharmacy team participating in the Fleetwood Phase III evaluation. Cross-sectional design; long-term care pharmacy provider in North Carolina (the implementation site of the large-scale Fleetwood Phase III study). All current pharmacy employees as of May/June 2002. None. Health Professional Stress Inventory and job satisfaction. Ninety-four percent (16/17) of consultant pharmacists were satisfied with their job, with 89% reporting they would definitely choose to be a pharmacist again. Seventy-five percent both of dispensing pharmacists and pharmacy technicians reported overall job satisfaction. Forty-one reported that they would not choose to be a pharmacist (pharmacy technician) again. The most frequently reported sources of stress among the dispensing pharmacists and pharmacy technicians were conflicts with non-work obligations (i.e., family, personal life) and the ability to perform duties with short staffing. In addition, inadequate pay and few opportunities for job advancement were often/frequent sources of stress among pharmacy technicians. More than one third of dispensing pharmacists also reported stress frequently because of fears of mistakes in patient treatment. Overall, consultants are very satisfied with their positions, although dispensing pharmacists and pharmacy technicians are less satisfied with their work. The reasons may be because of the different nature of each job, as well as staffing shortages. The extent to which the Fleetwood Model can improve job satisfaction and impact on stress will be evaluated once we resurvey the pharmacy team after the intervention period of the Fleetwood Phase III study.

Evaluation of medicines dispensing pattern of private pharmacies in Rajshahi, Bangladesh.

PubMed

Saha, Shuvashis; Hossain, Md Tawhid

2017-02-13

In developing country like BANGLADESH, people depend more on pharmacies due to expediency, shorter waiting time, cost reduction, availability of credit and flexible opening hours. The aim of this study was to investigate medicines dispensing patterns of the pharmacies in RAJSHAHI, BANGLADESH and to identify and analyze contribution of drugsellers and quacks in irrational drug use. This cross-sectional study was conducted during January 2016 - April, 2016 in 75 randomly selected private pharmacies including both licensed and unlicensed pharmacies of covering LAKSHMIPUR area. During the whole study process, total 7944 clients visited the pharmacies under observation and 24,717 medicines were dispensed. 22.70% of all these drugs were sold without a prescription. Out of the 5610 items dispensed without prescription, 66.2% were dispensed on the request of clients themselves and 33.8% on the recommendation of a drug seller. Number of medicine in a prescription was highly variable ranging from 2 to 5 medicines per prescriptions (mean = 3.03). The average number of medicines dispensed from each of the pharmacies during the observation period was 392, varied pharmacy to pharmacy - ranging from 194 to 588. Lowest selling medicines were sedative and hypnotics and highest selling medicines were antimicrobials. The recommendation rate for antibiotics was highest for the quacks (26.48%) though the major amount of the antimicrobials (n = 3039, 65.83%) were dispensed on prescription. Macrolides, quinolones, metronidazoles and cephalosporins are most favourite drug of quacks, clients and pharmacists. Majority of medicines were dispensed irrationally without any prescription and over the counter dispensing of many low safety profile drugs was common. The results and discussion presented in this paper will be helpful to provide a baseline to redirect further studies in this area.

The Relationship between Occurrence Timing of Dispensing Errors and Subsequent Danger to Patients under the Situation According to the Classification of Drugs by Efficacy.

PubMed

Tsuji, Toshikazu; Nagata, Kenichiro; Kawashiri, Takehiro; Yamada, Takaaki; Irisa, Toshihiro; Murakami, Yuko; Kanaya, Akiko; Egashira, Nobuaki; Masuda, Satohiro

2016-01-01

There are many reports regarding various medical institutions' attempts at the prevention of dispensing errors. However, the relationship between occurrence timing of dispensing errors and subsequent danger to patients has not been studied under the situation according to the classification of drugs by efficacy. Therefore, we analyzed the relationship between position and time regarding the occurrence of dispensing errors. Furthermore, we investigated the relationship between occurrence timing of them and danger to patients. In this study, dispensing errors and incidents in three categories (drug name errors, drug strength errors, drug count errors) were classified into two groups in terms of its drug efficacy (efficacy similarity (-) group, efficacy similarity (+) group), into three classes in terms of the occurrence timing of dispensing errors (initial phase errors, middle phase errors, final phase errors). Then, the rates of damage shifting from "dispensing errors" to "damage to patients" were compared as an index of danger between two groups and among three classes. Consequently, the rate of damage in "efficacy similarity (-) group" was significantly higher than that in "efficacy similarity (+) group". Furthermore, the rate of damage is the highest in "initial phase errors", the lowest in "final phase errors" among three classes. From the results of this study, it became clear that the earlier the timing of dispensing errors occurs, the more severe the damage to patients becomes.

Recent advances in inkjet dispensing technologies: applications in drug discovery.

PubMed

Zhu, Xiangcheng; Zheng, Qiang; Yang, Hu; Cai, Jin; Huang, Lei; Duan, Yanwen; Xu, Zhinan; Cen, Peilin

2012-09-01

Inkjet dispensing technology is a promising fabrication methodology widely applied in drug discovery. The automated programmable characteristics and high-throughput efficiency makes this approach potentially very useful in miniaturizing the design patterns for assays and drug screening. Various custom-made inkjet dispensing systems as well as specialized bio-ink and substrates have been developed and applied to fulfill the increasing demands of basic drug discovery studies. The incorporation of other modern technologies has further exploited the potential of inkjet dispensing technology in drug discovery and development. This paper reviews and discusses the recent developments and practical applications of inkjet dispensing technology in several areas of drug discovery and development including fundamental assays of cells and proteins, microarrays, biosensors, tissue engineering, basic biological and pharmaceutical studies. Progression in a number of areas of research including biomaterials, inkjet mechanical systems and modern analytical techniques as well as the exploration and accumulation of profound biological knowledge has enabled different inkjet dispensing technologies to be developed and adapted for high-throughput pattern fabrication and miniaturization. This in turn presents a great opportunity to propel inkjet dispensing technology into drug discovery.

Adverse selection? A multi-dimensional profile of people dispensed opioid analgesics for persistent non-cancer pain.

PubMed

Rogers, Kris D; Kemp, Anna; McLachlan, Andrew J; Blyth, Fiona

2013-01-01

This study investigates utilisation patterns for prescription opioid analgesics in the Australian community and how these are associated with a framework of individual-level factors related to healthcare use. Self-reported demographic and health information from participants in the 45 and Up Study cohort were linked to pharmaceutical claims from 2006-2009. Participants comprised 19,816 people with ≥1 opioid analgesic dispensing in the 12-months after recruitment to the cohort and 79,882 people not dispensed opioid analgesics. All participants were aged ≥45 years, were social security pharmaceutical beneficiaries, with no history of cancer. People dispensed opioid analgesics were classified as having acute (dispensing period <90 days), episodic (≥90 days and <3 'authority' prescriptions for increased quantity supply) or long-term treatment (≥90 days and ≥3 authority prescriptions). Of participants dispensed opioid analgesic 52% received acute treatment, 25% episodic treatment and 23% long-term treatment. People dispensed opioid analgesics long-term had an average of 14.9 opioid analgesic prescriptions/year from 2.0 doctors compared with 1.5 prescriptions from 1.1 doctors for people receiving acute treatment. People dispensed opioid analgesics reported more need-related factors such as poorer physical functioning and higher psychological distress. Long-term users were more likely to have access-related factors such as low-income and living outside major cities. After simultaneous adjustment, association with predisposing health factors and access diminished, but indicators of need such as osteoarthritis treatment, paracetamol use, and poor physical function were the strongest predictors for all opioid analgesic users. People dispensed opioid analgesics were in poorer health, reported higher levels of distress and poorer functioning than people not receiving opioid analgesics. Varying dispensing profiles were evident among people dispensed opioid analgesics for persistent pain, with those receiving episodic and long-term treatment dispensed the strongest opioid analgesics. The findings highlight the broad range of factors associated with longer term opioid analgesics use.

Dispensing Processes Impact Apparent Biological Activity as Determined by Computational and Statistical Analyses

PubMed Central

Ekins, Sean; Olechno, Joe; Williams, Antony J.

2013-01-01

Dispensing and dilution processes may profoundly influence estimates of biological activity of compounds. Published data show Ephrin type-B receptor 4 IC50 values obtained via tip-based serial dilution and dispensing versus acoustic dispensing with direct dilution differ by orders of magnitude with no correlation or ranking of datasets. We generated computational 3D pharmacophores based on data derived by both acoustic and tip-based transfer. The computed pharmacophores differ significantly depending upon dispensing and dilution methods. The acoustic dispensing-derived pharmacophore correctly identified active compounds in a subsequent test set where the tip-based method failed. Data from acoustic dispensing generates a pharmacophore containing two hydrophobic features, one hydrogen bond donor and one hydrogen bond acceptor. This is consistent with X-ray crystallography studies of ligand-protein interactions and automatically generated pharmacophores derived from this structural data. In contrast, the tip-based data suggest a pharmacophore with two hydrogen bond acceptors, one hydrogen bond donor and no hydrophobic features. This pharmacophore is inconsistent with the X-ray crystallographic studies and automatically generated pharmacophores. In short, traditional dispensing processes are another important source of error in high-throughput screening that impacts computational and statistical analyses. These findings have far-reaching implications in biological research. PMID:23658723

From prescriptions to drug use periods - things to notice.

PubMed

Tanskanen, Antti; Taipale, Heidi; Koponen, Marjaana; Tolppanen, Anna-Maija; Hartikainen, Sirpa; Ahonen, Riitta; Tiihonen, Jari

2014-11-14

Electronic prescription registers provide a vast data source for pharmacoepidemiological research. Prescriptions as such are not suitable for all research purposes; e.g., studying concurrent use of different drugs or adverse drug events during current use. For those purposes, data on dispensed prescriptions needs to be transformed to periods of drug use. We used 3,828,292 dispensed prescriptions claimed between 1 January 2002 and 31 December 2009 for 28,093 persons with Alzheimer's disease. Examples of drug use histories are presented to discuss different aspects that should be noticed when using register-based data consisting of drug purchases. There is no simple method for correctly transforming dispensed prescriptions to periods of drug use that is usable for all drugs and drug users. Fixed assumptions of daily dose (in defined daily doses, tablets or other units) and fixed time windows should be used with caution and adjusted for different drug use patterns. We recommend that when transforming prescription drug purchases to drug use periods personal dose, purchasing pattern and other behavioral differences between patients should be taken into account.

Dispensing of non-prescribed antibiotics in Jordan

PubMed Central

Almaaytah, Ammar; Mukattash, Tareq L; Hajaj, Julia

2015-01-01

Objective Current regulations in Jordan state that antibiotics cannot be sold without a medical prescription. This study aimed to assess the percentage of pharmacies that dispense antibiotics without a medical prescription in the Kingdom of Jordan and identify and highlight the extent and seriousness of such practices among Jordanian pharmacies. Methods A prospective study was performed, and five different clinical scenarios were simulated at pharmacies investigated including sore throat, otitis media, acute sinusitis, diarrhea, and urinary tract infection in childbearing-aged women. Three levels of demand were used to convince the pharmacists to sell an antibiotic. Results A total of 202 total pharmacies in Jordan were visited in the present study. The majority of pharmacies (74.3%) dispensed antibiotics without prescription with three different levels of demand. The percentage of pharmacies dispensing antibiotics without a prescription for the sore throat scenario was 97.6%, followed by urinary tract infection (83.3%), diarrhea (83%), and otitis media (68.4%). The lowest percentage of antibiotic dispensing was for the acute sinusitis simulation at 48.5%. Among the pharmacies that dispensed antibiotics, the pharmacists provided an explanation as the number of times per day the drug should be taken in 95.3% of the cases, explained the duration of treatment in 25.7%, and inquired about allergies prior to the sale of the antibiotic in only 17.3%. Only 52 pharmacies (25.7%) refused to dispense any kind of antibiotics, the majority (61.5%) of this refusal response came from acute sinusitis cases, while the minority (2.4%) came from the sore throat cases. Conclusion The results of this study demonstrate that antibiotics continue to be dispensed without prescription in Jordan in violation with national regulations regarding this practice. The findings of this study could provide a layout for governmental health authorities to implement strict enfrorcment of national regulations regarding antibiotic dispensing in order to avoid the serious complications that could arise in the future as a result of such practices. PMID:26491267

Controversy and consensus on a clinical pharmacist in primary care in the Netherlands.

PubMed

Hazen, Ankie C M; Wal, Aletta W van der; Sloeserwij, Vivianne M; Zwart, Dorien L M; Gier, Johan J de; Wit, Niek J de; Leendertse, Anne J; Bouvy, Marcel L; Bont, Antoinette A de

2016-10-01

Background Controversy about the introduction of a non-dispensing pharmacist in primary care practice hampers implementation. Objective The aim of this study is to systematically map the debate on this new role for pharmacists amongst all stakeholders to uncover and understand the controversy and consensus. Primary health care in the Netherlands. Method Q methodology. 163 participants rank-ordered statements on issues concerning the integration of a non-dispensing pharmacist in primary care practice. Stakeholder perspectives on the role of the non-dispensing pharmacist and pharmaceutical care in primary care. Results This study identified the consensus on various features of the non-dispensing pharmacist role as well as the financial, organisational and collaborative aspects of integrating a non-dispensing pharmacist in primary care practice. Q factor analysis revealed four perspectives: "the independent community pharmacist", "the independent clinical pharmacist", "the dependent clinical pharmacist" and "the medication therapy management specialist". These four perspectives show controversies to do with the level of professional independency of the non-dispensing pharmacist and the level of innovation of task performance. Conclusion Despite the fact that introducing new professional roles in healthcare can lead to controversy, the results of this Q study show the potential of a non-dispensing pharmacist as a pharmaceutical care provider and the willingness for interprofessional collaboration. The results from the POINT intervention study in the Netherlands will be an important next step in resolving current controversies.

Prescription opioid analgesics for pain management in Australia: 20 years of dispensing.

PubMed

Islam, M M; McRae, I S; Mazumdar, S; Taplin, S; McKetin, R

2016-08-01

Opioid prescribing/dispensing data can inform policy surrounding regulation by informing trends and types of opioid prescribed and geographic variations. In Australia so far only partial data on dispensing have been published, and data for states/territories remain unknown. Using a range of measures, this study examines 20-year (1992-2011) trends in prescription opioid analgesics in Australia - both nationally and for individual jurisdictions. Dispensing data were obtained from the Drug Utilisation Sub-Committee and the Pharmaceutical Benefits Scheme (PBS) websites. Trends in numbers of prescriptions and daily defined dose (DDD)/1000 people/day were examined over time and across states/territories. Seasonal variations in PBS/Repatriation Pharmaceutical Benefits Scheme (RPBS) items for nationwide dispensing were adjusted using a centred moving smoothing technique. In two decades, 165.32 million prescriptions for opioids were dispensed, with codeine and its derivatives the most prescribed formulation (50.1%) followed by tramadol (13.5%) and oxycodone derivatives (12.7%). In terms of DDD/1000 people/day, dispensing increased from 5.38 in 1992 to 14.46 in 2011. There are significant increasing trends for total, PBS/RPBS and under co-payment prescriptions (priced below patient co-payment). The DDD/1000 people/day for items dispensed through PBS/RPBS was highest in Tasmania. Prescription opioid dispensing increased substantially over the study period. With an ageing population, this trend is likely to continue in future. A growing concern about harms associated with opioid use warrants balanced control measures so that harms could be minimised without reducing effective pain treatment. Research examining utilisation in small geographic areas may help design spatially tailored interventions. A real-time drug-monitoring programme may reduce undue prescribing and dispensing. © 2016 Royal Australasian College of Physicians.

Perceptions of a campus-wide condom distribution programme: An exploratory study

PubMed Central

Francis, Diane B; Noar, Seth M; Widman, Laura; Willoughby, Jessica Fitts; Sanchez, Diana M; Garrett, Kyla P

2016-01-01

Objective Condom distribution programmes are an important means of preventing sexually transmitted infections (STIs); yet little research has examined their perceived and actual impact on college campuses. Design Quantitative, cross-sectional study. Setting Large public university in the Southeastern USA. Method Approximately 2 months after a campus-wide condom distribution programme began, we utilised intercept surveys with 355 students (68% women; 43% racial/ethnic minorities) to examine their perceptions of the availability, accessibility and acceptability of condoms, and their perceptions and use of the newly installed condom dispensers. Results Students perceived condoms to be available and accessible on campus after implementation of the condom dispensers. Students had heard about the dispensers from other people (36%), through social media (18%) and the campus newspaper (15%). Most students (71%) had seen the dispensers. Almost one in four students (23%) had taken a condom from the dispensers; among those who were sexually active during the 2months that the dispensers were available, 33% had used them. More than one-third of students (37%) – and 53% of sexually active students – indicated intentions to use the dispensers in the next 6months. Multiple regression analysis controlling for age, gender and race revealed that prior condom use, attitudes about the dispensers and comfort with the dispensers were significant predictors of sexually active students’ intentions to use the dispensers (p<.001). Conclusion Overall, results indicate that over a short time period, this condom distribution programme was successful in reaching students and providing free condoms. Implications for implementing condom distribution programmes on college campuses as well as future directions for research are discussed. PMID:27917002

Cluster randomized trial of text message reminders to retail staff in tanzanian drug shops dispensing artemether-lumefantrine: effect on dispenser knowledge and patient adherence.

PubMed

Bruxvoort, Katia; Festo, Charles; Kalolella, Admirabilis; Cairns, Matthew; Lyaruu, Peter; Kenani, Mitya; Kachur, S Patrick; Goodman, Catherine; Schellenberg, David

2014-10-01

Artemisinin combination therapies are available in private outlets, but patient adherence might be compromised by poor advice from dispensers. In this cluster randomized trial in drug shops in Tanzania, 42 of 82 selected shops were randomized to receive text message reminders about what advice to provide when dispensing artemether-lumefantrine (AL). Eligible patients purchasing AL at shops in both arms were followed up at home and questioned about each dose taken. Dispensers were interviewed regarding knowledge of AL dispensing practices and receipt of the malaria-related text messages. We interviewed 904 patients and 110 dispensers from 77 shops. Although there was some improvement in dispenser knowledge, there was no difference between arms in adherence measured as completion of all doses (intervention 68.3%, control 69.8%, p [adjusted] = 0.6), or as completion of each dose at the correct time (intervention 33.1%, control 32.6%, p [adjusted] = 0.9). Further studies on the potential of text messages to improve adherence are needed. © The American Society of Tropical Medicine and Hygiene.

Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers.

PubMed

Axelsson, Daniel; Blomberg, Marie

2017-10-01

The objective was to estimate whether maternal obesity and/or obstetric interventions are associated with diagnosed maternal post-partum sepsis. A retrospective observational cohort study including all deliveries in Sweden between 1997 and 2012 (N = 1,558,752). Cases of sepsis (n = 376) were identified by International Classification of Diseases, (ICD-10) codes A40, A41 and O 85 in the Medical Birth Register and the National Patient Register. The reference population was non-infected, and therefore, women with any other infection diagnosis and/or with dispensed antibiotics within eight weeks post-partum were excluded. Information on dispensed drugs was available in the prescribed drug Register. Women with sepsis were compared with non-infected women concerning maternal characteristics and obstetric interventions. Adjusted odds ratios (aOR) were determined using the Mantel-Haenszel technique. Adjustments were made for maternal age, parity and smoking. Obese women (body mass index ≥30) had a doubled risk of sepsis (3.6/10,000) compared with normal weight women (2.0/10,000) (aOR 1.85 (95%CI: 1.37-2.48)). Induction of labour (aOR 1.44 (95%CI: 1.09-1.91)), caesarean section overall (aOR 3.06 (95%CI: 2.49-3.77)) and elective caesarean section (aOR 2.41 (95%CI: 1.68-3.45)) increased the risk of sepsis compared with normal vaginal delivery. Post-partum anaemia due to acute blood loss was associated with maternal sepsis (aOR 3.40 (95%CI: 2.59-4.47)). Maternal obesity, obstetric interventions and post-partum anaemia due to acute blood loss increased the risk of diagnosed post-partum sepsis indicating that interventions in obstetric care should be considered carefully and anaemia should be treated if resources are available.

Adverse Selection? A Multi-Dimensional Profile of People Dispensed Opioid Analgesics for Persistent Non-Cancer Pain

PubMed Central

Rogers, Kris D.; Kemp, Anna; McLachlan, Andrew J.; Blyth, Fiona

2013-01-01

Objectives This study investigates utilisation patterns for prescription opioid analgesics in the Australian community and how these are associated with a framework of individual-level factors related to healthcare use. Methods Self-reported demographic and health information from participants in the 45 and Up Study cohort were linked to pharmaceutical claims from 2006–2009. Participants comprised 19,816 people with ≥1 opioid analgesic dispensing in the 12-months after recruitment to the cohort and 79,882 people not dispensed opioid analgesics. All participants were aged ≥45 years, were social security pharmaceutical beneficiaries, with no history of cancer. People dispensed opioid analgesics were classified as having acute (dispensing period <90 days), episodic (≥90 days and <3 ‘authority’ prescriptions for increased quantity supply) or long-term treatment (≥90 days and ≥3 authority prescriptions). Results Of participants dispensed opioid analgesic 52% received acute treatment, 25% episodic treatment and 23% long-term treatment. People dispensed opioid analgesics long-term had an average of 14.9 opioid analgesic prescriptions/year from 2.0 doctors compared with 1.5 prescriptions from 1.1 doctors for people receiving acute treatment. People dispensed opioid analgesics reported more need-related factors such as poorer physical functioning and higher psychological distress. Long-term users were more likely to have access-related factors such as low-income and living outside major cities. After simultaneous adjustment, association with predisposing health factors and access diminished, but indicators of need such as osteoarthritis treatment, paracetamol use, and poor physical function were the strongest predictors for all opioid analgesic users. Conclusions People dispensed opioid analgesics were in poorer health, reported higher levels of distress and poorer functioning than people not receiving opioid analgesics. Varying dispensing profiles were evident among people dispensed opioid analgesics for persistent pain, with those receiving episodic and long-term treatment dispensed the strongest opioid analgesics. The findings highlight the broad range of factors associated with longer term opioid analgesics use. PMID:24312456

Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices

PubMed Central

Butler, Chris C; Dunstan, Frank; Heginbothom, Margaret; Mason, Brendan; Roberts, Zoë; Hillier, Sharon; Howe, Robin; Palmer, Stephen; Howard, Anthony

2007-01-01

Background GPs are urged to prescribe antibiotics less frequently, despite lack of evidence linking reduced antibiotic prescribing with reductions in resistance at a local level. Aim To investigate associations between changes in antibiotic dispensing and changes in antibiotic resistance at general-practice level. Design of study Seven-year study of dispensed antibiotics and antibiotic resistance in coliform isolates from urine samples routinely submitted from general practice. Setting General practices in Wales. Method Multilevel modelling of trends in resistance to ampicillin and trimethoprim, and changes in practice total antibiotic dispensing and amoxicillin and trimethoprim dispensing. Results The primary analysis included data on 164 225 coliform isolates from urine samples submitted from 240 general practices over the 7-year study period. These practices served a population of 1.7 million patients. The quartile of practices that had the greatest decrease in total antibiotic dispensing demonstrated a 5.2% reduction in ampicillin resistance over the 7-year period with changes of 0.4%, 2.4%, and −0.3% in the other three quartiles. There was a statistically significant overall decrease in ampicillin resistance of 1.03% (95% confidence interval [CI] = 0.37 to 1.67%) per decrease of 50 amoxicillin items dispensed per 1000 patients per annum. There were also significant reductions in trimethoprim resistance in the two quartiles of practices that reduced total antibiotic dispensing most compared with those that reduced it least, with an overall decrease in trimethoprim resistance of 1.08% (95% CI = 0.065 to 2.10%) per decrease of 20 trimethoprim items dispensed per 1000 patients per annum. Main findings were confirmed by secondary analyses of 256 370 isolates from 527 practices that contributed data at some point during the study period. Conclusion Reducing antibiotic dispensing at general-practice level is associated with reduced local antibiotic resistance. These findings should further encourage clinicians and patients to use antibiotics conservatively. PMID:17925135

Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study

PubMed Central

Saxena, Pikee; Mishra, Archana; Nigam, Aruna

2016-01-01

Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter. PMID:27385872

The comfort factor: assessing patient satisfaction with Opti-Free vs other contact lens cleaning products.

PubMed

Yeaton, K

1994-01-01

Many patients cite comfort as a primary factor in their success or failure with soft contact lenses. In an effort to further meet the needs of these patients, eye-care professionals must place more emphasis on dispensing a lens type and lens-care system that maximize patient satisfaction and thus provide a higher quality of service. This study delineated patient-defined quality and comfort as they relate to lens-care solutions. Five hundred ninety-nine U.S. practices were each asked to switch 25 of their patients to Opti-Free Lens Care from their currently used lens-care system (52% ReNu Multi-Purpose Solution, 20% AOSept System) for 2 weeks. Data were collected from 14,455 patients who completed the post-trial interview. At the time of the callback interview, 81% of respondents (78% ReNu users, 82% AOSept users) were using the Opti-Free System. Of these patients, 85% (84% previous ReNu users, 87% previous AOSept users) rated Opti-Free Lens Care more comfortable than or as comfortable as their previous system. These findings demonstrate differences in patient comfort among Opti-Free, AOSept, and ReNu. Eye-care professionals should consider relative comfort when dispensing lens-care systems, as this may affect patient-defined quality.

A study of the additional costs of dispensing workers' compensation prescriptions.

PubMed

Schafermeyer, Kenneth W

2007-03-01

Although there is a significant amount of additional work involved in dispensing workers' compensation prescriptions, these costs have not been quantified. A study of the additional costs to dispense a workers' compensation prescription is needed to measure actual costs and to help determine the reasonableness of reimbursement for prescriptions dispensed under workers' compensation programs. The purpose of this study was to determine the minimum additional time and costs required to dispense workers' compensation prescriptions in Texas. A convenience sample of 30 store-level pharmacy staff members involved in submitting and processing prescription claims for the Texas Mutual workers' compensation program were interviewed by telephone. Data collected to determine the additional costs of dispensing a workers' compensation prescription included (1) the amount of additional time and personnel costs required to dispense and process an average workers' compensation prescription claim, (2) the difference in time required for a new versus a refilled prescription, (3) overhead costs for processing workers' compensation prescription claims by experienced experts at a central processing facility, (4) carrying costs for workers' compensation accounts receivable, and (5) bad debts due to uncollectible workers' compensation claims. The median of the sample pharmacies' additional costs for dispensing a workers' compensation prescription was estimated to be at least $9.86 greater than for a cash prescription. This study shows that the estimated costs for workers' compensation prescriptions were significantly higher than for cash prescriptions. These costs are probably much more than most employers, workers' compensation payers, and pharmacy managers would expect. It is recommended that pharmacy managers should estimate their own costs and compare these costs to actual reimbursement when considering the reasonableness of workers' compensation prescriptions and whether to accept these prescriptions.

A conserved catalytic residue in the ubiquitin-conjugating enzyme family

PubMed Central

Wu, Pei-Ying; Hanlon, Mary; Eddins, Michael; Tsui, Colleen; Rogers, Richard S.; Jensen, Jane P.; Matunis, Michael J.; Weissman, Allan M.; Wolberger, Cynthia P.; Pickart, Cecile M.

2003-01-01

Ubiquitin (Ub) regulates diverse functions in eukaryotes through its attachment to other proteins. The defining step in this protein modification pathway is the attack of a substrate lysine residue on Ub bound through its C-terminus to the active site cysteine residue of a Ub-conjugating enzyme (E2) or certain Ub ligases (E3s). So far, these E2 and E3 cysteine residues are the only enzyme groups known to participate in the catalysis of conjugation. Here we show that a strictly conserved E2 asparagine residue is critical for catalysis of E2- and E2/RING E3-dependent isopeptide bond formation, but dispensable for upstream and downstream reactions of Ub thiol ester formation. In constrast, the strictly conserved histidine and proline residues immediately upstream of the asparagine are dispensable for catalysis of isopeptide bond formation. We propose that the conserved asparagine side chain stabilizes the oxyanion intermediate formed during lysine attack. The E2 asparagine is the first non-covalent catalytic group to be proposed in any Ub conjugation factor. PMID:14517261

Association of emergency department albuterol dispensing with pediatric asthma revisits and readmissions.

PubMed

Hall, A Brad; Novotny, April; Bhisitkul, Donna M; Melton, James; Regan, Tim; Leckie, Maureen

2017-06-01

Although pediatric asthma continues to be a highly studied disease, data to suggest clear strategies to decrease asthma related revisits or readmissions is lacking. The purpose of our study was to assess the effect of emergency department (ED) direct dispensing of beta-agonist metered dose inhalers on pediatric asthma ED revisit and readmission rates. We conducted a retrospective cohort study of pediatric patients discharged from the pediatric ED with a diagnosis of asthma. Our primary outcome measured the rate of asthma revisits to the ED or admissions to the hospital within 28 days. Logistic regression analysis was used to assess ED beta-agonist MDI dispensing and revisit and/or readmission as the outcome. A total of 853 patients met eligibility for inclusion in the study, with 657 enrolled in the Baseline group and 196 enrolled in the ED-MDI group. The Baseline group experienced a revisit and readmission rate of 7.0% (46/657) versus 2.6% (5/196) in the ED-MDI group, (p = 0.026). ED direct dispensing of MDIs was found to be independently associated with a decreased risk of revisit or readmission (odds ratio 0.37; 95% confidence interval 0.14-0.95). In our study, ED direct dispensing of beta-agonist MDIs resulted in a reduction in 28-day revisit and readmission to the hospital. Further studies should be performed to evaluate the economic impact of reducing these revisits and readmissions against the costs of maintaining a dispensing program. Our findings may support modification of asthma programs to include dispensing MDIs from the emergency department.

Cold Shock Domain Family Members YB-1 and MSY4 Share Essential Functions during Murine Embryogenesis▿ †

PubMed Central

Lu, Zhi Hong; Books, Jason T.; Ley, Timothy J.

2006-01-01

Three cold shock domain (CSD) family members (YB-1, MSY2, and MSY4) exist in vertebrate species ranging from frogs to humans. YB-1 is expressed throughout embryogenesis and is ubiquitously expressed in adult animals; it protects cells from senescence during periods of proliferative stress. YB-1-deficient embryos die unexpectedly late in embryogenesis (embryonic day 18.5 [E18.5] to postnatal day 1) with a runting phenotype. We have now determined that MSY4, but not MSY2, is also expressed during embryogenesis; its abundance declines substantially from E9.5 to E17.5 and is undetectable on postnatal day 1(adult mice express MSY4 in testes only). Whole-mount analysis revealed similar patterns of YB-1 and MSY4 RNA expression in E11.5 embryos. To determine whether MSY4 delays the death of YB-1-deficient embryos, we created and analyzed MSY4-deficient mice and then generated YB-1 and MSY4 double-knockout embryos. MSY4 is dispensable for normal development and survival, but the testes of adult mice have excessive spermatocyte apoptosis and seminiferous tubule degeneration. Embryos doubly deficient for YB-1 and MSY4 are severely runted and die much earlier (E8.5 to E11.5) than YB-1-deficient embryos, suggesting that MSY4 indeed shares critical cellular functions with YB-1 in the embryonic tissues where they are coexpressed. PMID:16954378

An automatic pellet dispenser for precise control of feeding topography in granivorous birds

PubMed Central

Berkhoudt, H.; Van Der Reijden, D.; Heijmans, M.

1987-01-01

Design and construction of an automatic pellet dispenser for granivorous birds are described. The dispenser permits rapid pneumatic delivery of pellets (five pellets per second maximum) to one controlled position and does not interfere with simultaneous electrophysiological recording. In addition, the device continuously indicates presence or absence of a pellet in the delivery position. This automatic dispenser proved very effective in our studies of stereotyped topographies of feeding in granivorous birds, such as pigeons and chickens. PMID:16812503

Occurrence of heterotrophic and coliform bacteria in liquid hand soaps from bulk refillable dispensers in public facilities.

PubMed

Chattman, Marisa; Gerba, Sheri L; Maxwell, Charles P

2011-03-01

The goal of the study discussed in this article was to determine the occurrence of heterotrophic and coliform bacteria in liquid soap from bulk refillable dispensers, obtained from restrooms in a variety of public facilities. A total of 541 samples was collected from five U.S. cities. Liquid soap from dispensers in public areas was found to contain heterotrophic and coliform bacterial numbers averaging more than 106 CFU/mL in 24.8% of the dispensers.

Plug-in nanoliter pneumatic liquid dispenser with nozzle design flexibility

PubMed Central

Choi, In Ho; Kim, Hojin; Lee, Sanghyun; Baek, Seungbum; Kim, Joonwon

2015-01-01

This paper presents a novel plug-in nanoliter liquid dispensing system with a plug-and-play interface for simple and reversible, yet robust integration of the dispenser. A plug-in type dispenser was developed to facilitate assembly and disassembly with an actuating part through efficient modularization. The entire process for assembly and operation of the plug-in dispenser is performed via the plug-and-play interface in less than a minute without loss of dispensing quality. The minimum volume of droplets pneumatically dispensed using the plug-in dispenser was 124 nl with a coefficient of variation of 1.6%. The dispensed volume increased linearly with the nozzle size. Utilizing this linear relationship, two types of multinozzle dispensers consisting of six parallel channels (emerging from an inlet) and six nozzles were developed to demonstrate a novel strategy for volume gradient dispensing at a single operating condition. The droplet volume dispensed from each nozzle also increased linearly with nozzle size, demonstrating that nozzle size is a dominant factor on dispensed volume, even for multinozzle dispensing. Therefore, the proposed plug-in dispenser enables flexible design of nozzles and reversible integration to dispense droplets with different volumes, depending on the application. Furthermore, to demonstrate the practicality of the proposed dispensing system, we developed a pencil-type dispensing system as an alternative to a conventional pipette for rapid and reliable dispensing of minute volume droplets. PMID:26594263

Plug-in nanoliter pneumatic liquid dispenser with nozzle design flexibility.

PubMed

Choi, In Ho; Kim, Hojin; Lee, Sanghyun; Baek, Seungbum; Kim, Joonwon

2015-11-01

This paper presents a novel plug-in nanoliter liquid dispensing system with a plug-and-play interface for simple and reversible, yet robust integration of the dispenser. A plug-in type dispenser was developed to facilitate assembly and disassembly with an actuating part through efficient modularization. The entire process for assembly and operation of the plug-in dispenser is performed via the plug-and-play interface in less than a minute without loss of dispensing quality. The minimum volume of droplets pneumatically dispensed using the plug-in dispenser was 124 nl with a coefficient of variation of 1.6%. The dispensed volume increased linearly with the nozzle size. Utilizing this linear relationship, two types of multinozzle dispensers consisting of six parallel channels (emerging from an inlet) and six nozzles were developed to demonstrate a novel strategy for volume gradient dispensing at a single operating condition. The droplet volume dispensed from each nozzle also increased linearly with nozzle size, demonstrating that nozzle size is a dominant factor on dispensed volume, even for multinozzle dispensing. Therefore, the proposed plug-in dispenser enables flexible design of nozzles and reversible integration to dispense droplets with different volumes, depending on the application. Furthermore, to demonstrate the practicality of the proposed dispensing system, we developed a pencil-type dispensing system as an alternative to a conventional pipette for rapid and reliable dispensing of minute volume droplets.

Comparison of prescription reimbursement methodologies in Japan and the United States.

PubMed

Akaho, Eiichi; MacLaughlin, Eric J; Takeuchi, Yoshikazu

2003-01-01

To compare methods of prescription reimbursement in Japan and the United States. Data were obtained through interviews and a search of the pharmacy literature using MEDLINE, International Pharmaceutical Abstracts, the Iowa Drug Information Service, and the Internet. Search terms were pharmacy, dispensing fee, reimbursement, prescriptions, Japan, United States, and average wholesale price (AWP). A comprehensive search was done (i.e., no year limits were observed). Performed manually by the authors. The reimbursement systems for prescriptions differ widely between Japan and the United States. The reimbursement system in the United States is fairly straightforward and easy to understand; it is generally based on product cost (e.g., AWP minus a percentage) plus a small dispensing fee. The system in Japan is extremely complex. Reimbursement formulae have four components, including fees for professional dispensing, drug cost, counseling and administration, and medication supplies and devices. Additionally, various adjustments to the final amount are made based on dosage form, length of therapy, number of prescriptions dispensed by the pharmacy per month, and when the prescription is filled (e.g., after hours, on Sundays or holidays). In Japan, each pharmacist is limited to filling 40 prescriptions per day, but each "prescription" can involve several medication orders, making it difficult to compare Japanese pharmacists' workloads with those of their counterparts in the United States. In addition, Japanese pharmacists are provided remuneration for providing various cognitive services, such as taking a patient history, counseling a patient, consulting with a physician, and identifying drug-related problems. Japan and the United States have very different methods of reimbursing pharmacists for dispensing prescriptions, each with positive and negative features. Based on the features of pharmacy reimbursement systems in each country, perhaps the optimal pharmacy practice system would have workload limits that reflect safety standards and amount of support staff available, provide a fair and standardized method for determining drug cost, are relatively straightforward, pay for cognitive services, and provide care for all of citizens through of some type of national health care system.

Molecular Epidemiology of a Pseudomonas aeruginosa Hospital Outbreak Driven by a Contaminated Disinfectant-Soap Dispenser

PubMed Central

Lanini, Simone; D'Arezzo, Silvia; Puro, Vincenzo; Martini, Lorena; Imperi, Francesco; Piselli, Pierluca; Montanaro, Marco; Paoletti, Simonetta; Visca, Paolo; Ippolito, Giuseppe

2011-01-01

Background and Objective Pseudomonas aeruginosa infection represents a main cause of morbidity and mortality among immunocompromised patients. This study describes a fatal epidemic of P. aeruginosa that occurred in a hematology unit in Italy. Methods Retrospective cohort study, prospective surveillance, auditing, extensive testing on healthcare workers and environmental investigation were performed to define the dynamics and potential causes of transmission. RAPD, macrorestriction analyses and sequence typing were used to define relationships between P. aeruginosa isolates. Results Eighteen cases of infection were identified in the different phases of the investigation. Of these, five constitute a significant molecular cluster of infection. A P. aeruginosa strain with the same genetic fingerprint and sequence type (ST175) as clinical isolates strain was also isolated from a heavily contaminated triclosan soap dispenser. Discussion and Conclusions Our results are consistent with the hypothesis that patients became indirectly infected, e.g., during central venous catheter handling through contaminated items, and that the triclosan soap dispenser acted as a common continuous source of P. aeruginosa infection. Since P. aeruginosa is intrinsically unsusceptible to triclosan, the use of triclosan-based disinfectant formulations should be avoided in those healthcare settings hosting patients at high risk of P. aeruginosa infection. PMID:21359222

Preliminary Assessment of Spatial Competition in the Market for E85: Presentation Supplement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clinton, Bentley; Johnson, Caley; Moriarty, Kristi

Anecdotal evidence suggests retail E85 prices may track retail gasoline prices rather than wholesale costs. This indicates E85 prices may be higher than they would be if priced on a cost basis hence limiting adoption by some price-sensitive consumers. Using publicly available and proprietary E85 and regular gasoline price data, we examine pricing behavior in the market for E85. Specifically, we assess the extent to which local retail competition in E85 markets decreases E85 retail prices. Results of econometric analysis suggest that higher levels of retail competition (measured in terms of station density) are associated with lower E85 prices atmore » the pump. While more precise causal estimates may be produced from more comprehensive data, this study is the first to our knowledge that estimates the spatial competition dimension of E85 pricing behavior by firms. This technical report elaborates on a related presentation.« less

GPs' prescription routines and cooperation with other healthcare personnel before and after implementation of multidose drug dispensing.

PubMed

Wekre, Liv Johanne; Bakken, Kjersti; Garåsen, Helge; Grimsmo, Anders

2012-08-01

This study addresses GPs' attitudes towards multidose drug dispensing before and after implementation and their perceived experience of how multidose drug dispensing affects prescription and communication routines for patients in the home care services. This study contributes to a method triangulation with two other studies on the introduction of multidose drug dispensing in Trondheim. A controlled before-and-after study carried out in Trondheim (intervention) and Tromsø (control). A questionnaire was distributed to all GPs in the two towns in 2005 with a follow-up questionnaire in 2008. The GPs in Trondheim showed a positive attitude to multidose drug dispensing both before and after the implementation. Increased workload was reported, but still the GPs wanted the system to be continued. Most of the GPs reported a better overview of the patients' medication and a supposed reduction in medication errors. The GPs' prescription- and communication routines were changed only for the multidose drug users and not for the other patients in the home care services. The study supports the results presented in two previous publications according to GPs' positive attitude towards multidose drug dispensing, their better overview of the patients' medications, and improved cooperation with the pharmacy. This study adds to our understanding of prescription routines among GPs and the use of the medication module in the electronic health record.

Perception of Community Pharmacists towards Dispensing Errors in Community Pharmacy Setting in Gondar Town, Northwest Ethiopia

PubMed Central

2017-01-01

Background Dispensing errors are inevitable occurrences in community pharmacies across the world. Objective This study aimed to identify the community pharmacists' perception towards dispensing errors in the community pharmacies in Gondar town, Northwest Ethiopia. Methods A cross-sectional study was conducted among 47 community pharmacists selected through convenience sampling. Data were analyzed using SPSS version 20. Descriptive statistics, Mann–Whitney U test, and Pearson's Chi-square test of independence were conducted with P ≤ 0.05 considered statistically significant. Result The majority of respondents were in the 23–28-year age group (N = 26, 55.3%) and with at least B.Pharm degree (N = 25, 53.2%). Poor prescription handwriting and similar/confusing names were perceived to be the main contributing factors while all the strategies and types of dispensing errors were highly acknowledged by the respondents. Group differences (P < 0.05) in opinions were largely due to educational level and age. Conclusion Dispensing errors were associated with prescribing quality and design of dispensary as well as dispensing procedures. Opinion differences relate to age and educational status of the respondents. PMID:28612023

Perception of Community Pharmacists towards Dispensing Errors in Community Pharmacy Setting in Gondar Town, Northwest Ethiopia.

PubMed

Asmelashe Gelayee, Dessalegn; Binega Mekonnen, Gashaw

2017-01-01

Dispensing errors are inevitable occurrences in community pharmacies across the world. This study aimed to identify the community pharmacists' perception towards dispensing errors in the community pharmacies in Gondar town, Northwest Ethiopia. A cross-sectional study was conducted among 47 community pharmacists selected through convenience sampling. Data were analyzed using SPSS version 20. Descriptive statistics, Mann-Whitney U test, and Pearson's Chi-square test of independence were conducted with P ≤ 0.05 considered statistically significant. The majority of respondents were in the 23-28-year age group ( N = 26, 55.3%) and with at least B.Pharm degree ( N = 25, 53.2%). Poor prescription handwriting and similar/confusing names were perceived to be the main contributing factors while all the strategies and types of dispensing errors were highly acknowledged by the respondents. Group differences ( P < 0.05) in opinions were largely due to educational level and age. Dispensing errors were associated with prescribing quality and design of dispensary as well as dispensing procedures. Opinion differences relate to age and educational status of the respondents.

Evaluation of community pharmacies regarding dispensing practices of antibiotics in two districts of central Nepal.

PubMed

Ansari, Mukhtar

2017-01-01

To evaluate the status of community pharmacies, their staff, and practices toward dispensing antibiotics. Cross-sectional, prospective. Community pharmacies in two districts of central Nepal, from March 2016 to May 2016. A systematic random sampling approach was adopted to sample 161 community pharmacies. Data on the registration status of pharmacies, qualification or training of dispensing staff, and the practice of dispensing antibiotics were collected using a pre-tested questionnaire. Face to face interviews were carried out by a previously trained interviewer. Data were analyzed for descriptive and inferential statistics using IBM SPSS Statistics 21. Among 161 community pharmacies, 25% were not registered and most of them were located in rural areas. It was typical (66.5%) to dispense antibiotics without prescription and most (91.4%) of the staffs involved in dispensing were non-pharmacists. Furthermore, the study revealed common practices of replacing one brand of antibiotic with other brands (66%), dispensing incomplete courses of antibiotics (73%), and not giving any advice regarding antibiotic use (39%) or completion of a full course of therapy (80%). There were significant (p < 0.001) relationships between the location of pharmacies (rural vs urban) and the qualifications of the pharmacy staff. Dispensing antibiotics without prescription and by non-pharmacists are common in this region. The study also found several issues regarding the irrational use of antibiotics. Thus, there is an urgent need to address these issues and promote the informed use of antibiotics.

Integration of a Community Pharmacy Simulation Program into a Therapeutics Course.

PubMed

Shin, Jaekyu; Tabatabai, Daryush; Boscardin, Christy; Ferrone, Marcus; Brock, Tina

2018-02-01

Objective. To demonstrate the feasibility of integrating the computer simulation, MyDispense, into a therapeutics course and to measure its effects on student perception and learning. Methods. We conducted a prospective study with an experimental phase and an implementation phase. In the first phase, students were randomized to complete a therapeutics case using MyDispense or traditional paper methods in class. In the second phase, all students completed two therapeutic cases using MyDispense in class with the option to complete four additional outside-of-class cases using MyDispense. Students completed pre- and post-tests in class and three surveys. Results. In the experimental phase, mean test scores increased from pre- to post-test for both MyDispense and traditional paper groups, but the difference between the groups was not statistically significant. Students in the traditional paper group reported statistically significant gains in confidence compared to the MyDispense group. In the implementation phase, mean test scores again increased, however, student perception of the use of MyDispense for therapeutics was negative. Completing the optional outside-of-class cases, however, was positively and significantly correlated with the midterm and final examination scores. Conclusion. Implementation of MyDispense in therapeutics may be feasible and has positive effects (eg, correlation with exam scores, capacity for immediate feedback, and potential for effective self-study). With short-term use and in the absence of assessment methods that also require seeking information from patients, students prefer to learn via traditional paper cases.

Influence of technique used to attach the infusion set to peristaltic finger smart-pumps on dispensing time: an experimental study.

PubMed

Umemura, Masayuki; Maegawa, Kanae; Arai, Daichi; Shigeno, Katsuro; Wakiya, Yoshifumi

2018-01-01

Infusion sets designed for peristaltic finger smart pumps (PFSPs) are necessary for the pumps' accurate handling. We previously found that medication dispensing is occasionally incomplete following the calculated infusion time when using certain combinations of PFSPs and infusion sets at a Japanese hospital. Thus, in this study, we investigated the cause of this observed delay by determining the effect of infusion set attachment technique on dispensing time using a combination of three kinds of PFSPs and five kinds of polyvinyl chloride (PVC) and polybutadiene (PB) infusion sets. PFSPs with their exclusive infusion sets were used. The PVC and PB infusion sets were either not stretched or stretched to 1-3 cm and attached to the PFSP's liquid delivery system. PFSP dispensing rates were set at 25-400 mL/h. The primary outcome was the time required to dispense 100 mL of saline in a volumetric flask. The complete dispensing time correlated with the input time for all equipment combinations when the infusion sets were not stretched before attachment to the PFSP (R 2  = 0.9998-1.0000). When stretched, the complete dispensing time was longer than the input time ( P  < 0.01-0.05, analysis of variance with Tukey-Kramer multiple comparisons). The maximum dispensing time extension ratio for the PVC and PB infusion sets was 141.8% and 113.0%, respectively. Certain attachment techniques for infusion sets can adversely prolong drug dispensing time. As such, pharmacists should provide medical staff with information about the devices used to administer drugs, as well as about the drugs themselves.

The Portuguese generic medicines market: a policy analysis

PubMed Central

Simoens, Steven

2008-01-01

Objectives: This study aims to conduct a descriptive analysis of the policy environment surrounding the generic medicines retail market in Portugal. The policy analysis focuses on supply-side measures (i.e. market access, pricing, reference-pricing and reimbursement of generic medicines) and demand-side measures (i.e. incentives for physicians to prescribe, for pharmacists to dispense and for patients to use generic medicines). Methods: The policy analysis was based on an international literature review. Also, a simulation exercise was carried out to compute potential savings from substituting generic for originator medicines in Portugal using IMS Health data. Results: Portugal has developed a successful generic medicines market by increasing reimbursement of generic medicines (until October 2005), by introducing a reference-pricing system, by encouraging physicians to prescribe by international non-proprietary name (INN), and by allowing generic substitution by pharmacists. However, the development of the generic medicines market has been hindered by the existence of copies, pricing regulation, certain features of the reference-pricing system, weak incentives for physicians to prescribe generic medicines and a financial disincentive for pharmacists to dispense generic medicines. Increased generic substitution would be expected to reduce public expenditure on originator medicines by 45%. Conclusions: The development of the Portuguese generic medicines market has mainly been fuelled by supply-side measures. To support the further expansion of the market, policy makers need to strengthen demand-side measures inciting physicians to prescribe, pharmacists to dispense and patients to use generic medicines. PMID:25152781

Determinants of community pharmacists' quality of care: a population-based cohort study using pharmacy administrative claims data.

PubMed

Winslade, Nancy; Tamblyn, Robyn

2017-09-21

To determine if a prototype pharmacists' services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists' performance can be used to identify characteristics of pharmacies providing higher quality of care. Population-based cohort study using community pharmacy claims from 1 November 2009 to 30 June 2010. All community pharmacies in Quebec, Canada. 1742 pharmacies dispensing 8 655 348 antihypertensive prescriptions to 760 700 patients. Patient adherence to antihypertensive medications. Pharmacy level: dispensing workload, volume of pharmacist-provided professional services (eg, refusals to dispense, pharmacotherapy recommendations), pharmacy location, banner/chain, pharmacist overlap and within-pharmacy continuity of care. Patient level: sex, age, income, patient prescription cost, new/chronic therapy, single/multiple antihypertensive medications, single/multiple prescribers and single/multiple dispensing pharmacies. Dispensing level: prescription duration, time of day dispensed and antihypertensive class. Multivariate alternating logistic regression estimated predictors of the primary outcome, accounting for patient and pharmacy clustering. 9.2% of dispensings of antihypertensive medications were provided to non-adherent patients. Male sex, decreasing age, new treatment, multiple prescribers and multiple dispensing pharmacies were risk factors for increased non-adherence. Pharmacies that provided more professional services were less likely to dispense to non-adherent hypertensive patients (OR: 0.60; 95% CI: 0.57 to 0.62) as were those with better scores on the Within-Pharmacy Continuity of Care Index. Neither increased pharmacists' services for improving antihypertensive adherence per se nor increased pharmacist overlap impacted the odds of non-adherence. However, pharmacist overlap was strongly correlated with dispensing workload. There was significant unexplained variability among pharmacies belonging to different banners and chains. Pharmacy administrative claims data can be used to calculate pharmacy-level characteristics associated with improved quality of care. This study supports the importance of pharmacist's professional services and continuity of pharmacist's care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Bacterial hand contamination and transfer after use of contaminated bulk-soap-refillable dispensers.

PubMed

Zapka, Carrie A; Campbell, Esther J; Maxwell, Sheri L; Gerba, Charles P; Dolan, Michael J; Arbogast, James W; Macinga, David R

2011-05-01

Bulk-soap-refillable dispensers are prone to extrinsic bacterial contamination, and recent studies demonstrated that approximately one in four dispensers in public restrooms are contaminated. The purpose of this study was to quantify bacterial hand contamination and transfer after use of contaminated soap under controlled laboratory and in-use conditions in a community setting. Under laboratory conditions using liquid soap experimentally contaminated with 7.51 log(10) CFU/ml of Serratia marcescens, an average of 5.28 log(10) CFU remained on each hand after washing, and 2.23 log(10) CFU was transferred to an agar surface. In an elementary-school-based field study, Gram-negative bacteria on the hands of students and staff increased by 1.42 log(10) CFU per hand (26-fold) after washing with soap from contaminated bulk-soap-refillable dispensers. In contrast, washing with soap from dispensers with sealed refills significantly reduced bacteria on hands by 0.30 log(10) CFU per hand (2-fold). Additionally, the mean number of Gram-negative bacteria transferred to surfaces after washing with soap from dispensers with sealed-soap refills (0.06 log(10) CFU) was significantly lower than the mean number after washing with contaminated bulk-soap-refillable dispensers (0.74 log(10) CFU; P < 0.01). Finally, significantly higher levels of Gram-negative bacteria were recovered from students (2.82 log(10) CFU per hand) than were recovered from staff (2.22 log(10) CFU per hand) after washing with contaminated bulk soap (P < 0.01). These results demonstrate that washing with contaminated soap from bulk-soap-refillable dispensers can increase the number of opportunistic pathogens on the hands and may play a role in the transmission of bacteria in public settings.

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review.

PubMed

Hazen, Ankie C M; de Bont, Antoinette A; Boelman, Lia; Zwart, Dorien L M; de Gier, Johan J; de Wit, Niek J; Bouvy, Marcel L

2018-03-01

A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispensing pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. In this literature review we searched two electronic databases and the reference list of published literature reviews for studies about clinical pharmacy services performed by non-dispensing pharmacists physically co-located in primary care practice. We assessed the degree of integration via key dimensions of integration based on the conceptual framework of Walshe and Smith. We included English language studies of any design that had a control group or baseline comparison published from 1966 to June 2016. Descriptive statistics were used to correlate the degree of integration to health outcomes. The analysis was stratified for disease-specific and patient-centered clinical pharmacy services. Eighty-nine health outcomes in 60 comparative studies contributed to the analysis. The accumulated evidence from these studies shows no impact of the degree of integration of non-dispensing pharmacists on health outcomes. For disease specific clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 55%, 57% and 70%. Full integration adds value to patient-centered clinical pharmacy services, but not to disease-specific clinical pharmacy services. To obtain maximum benefits of clinical pharmacy services for patients with multiple medications and comorbidities, full integration of non-dispensing pharmacists should be promoted. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Analyzing implementation dynamics using theory-driven evaluation principles: lessons learnt from a South African centralized chronic dispensing model.

PubMed

Magadzire, Bvudzai Priscilla; Marchal, Bruno; Mathys, Tania; Laing, Richard O; Ward, Kim

2017-12-04

Centralized dispensing of essential medicines is one of South Africa's strategies to address the shortage of pharmacists, reduce patients' waiting times and reduce over-crowding at public sector healthcare facilities. This article reports findings of an evaluation of the Chronic Dispensing Unit (CDU) in one province. The objectives of this process evaluation were to: (1) compare what was planned versus the actual implementation and (2) establish the causal elements and contextual factors influencing implementation. This qualitative study employed key informant interviews with the intervention's implementers (clinicians, managers and the service provider) [N = 40], and a review of policy and program documents. Data were thematically analyzed by identifying the main influences shaping the implementation process. Theory-driven evaluation principles were applied as a theoretical framework to explain implementation dynamics. The overall participants' response about the CDU was positive and the majority of informants concurred that the establishment of the CDU to dispense large volumes of medicines is a beneficial strategy to address healthcare barriers because mechanical functions are automated and distribution of medicines much quicker. However, implementation was influenced by the context and discrepancies between planned activities and actual implementation were noted. Procurement inefficiencies at central level caused medicine stock-outs and affected CDU activities. At the frontline, actors were aware of the CDU's implementation guidelines regarding patient selection, prescription validity and management of non-collected medicines but these were adapted to accommodate practical realities and to meet performance targets attached to the intervention. Implementation success was a result of a combination of 'hardware' (e.g. training, policies, implementation support and appropriate infrastructure) and 'software' (e.g. ownership, cooperation between healthcare practitioners and trust) factors. This study shows that health system interventions have unpredictable paths of implementation. Discrepancies between planned and actual implementation reinforce findings in existing literature suggesting that while tools and defined operating procedures are necessary for any intervention, their successful application depends crucially on the context and environment in which implementation occurs. We anticipate that this evaluation will stimulate wider thinking about the implementation of similar models in low- and middle-income countries.

Exploring safety systems for dispensing in community pharmacies: focusing on how staff relate to organizational components.

PubMed

Harvey, Jasmine; Avery, Anthony J; Ashcroft, Darren; Boyd, Matthew; Phipps, Denham L; Barber, Nicholas

2015-01-01

Identifying risk is an important facet of a safety practice in an organization. To identify risk, all components within a system of operation should be considered. In clinical safety practice, a team of people, technologies, procedures and protocols, management structure and environment have been identified as key components in a system of operation. To explore risks in relation to prescription dispensing in community pharmacies by taking into account relationships between key components that relate to the dispensing process. Fifteen community pharmacies in England with varied characteristics were identified, and data were collected using non-participant observations, shadowing and interviews. Approximately 360 hours of observations and 38 interviews were conducted by the team. Observation field notes from each pharmacy were written into case studies. Overall, 52,500 words from 15 case studies and interview transcripts were analyzed using thematic and line-by-line analyses. Validation techniques included multiple data collectors co-authoring each case study for consensus, review of case studies by members of the wider team including academic and practicing community pharmacists, and patient safety experts and two presentations (internally and externally) to review and discuss findings. Risks identified were related to relationships between people and other key components in dispensing. This included how different levels of staff communicated internally and externally, followed procedures, interacted with technical systems, worked with management, and engaged with the environment. In a dispensing journey, the following categories were identified which show how risks are inextricably linked through relationships between human components and other key components: 1) dispensing with divided attention; 2) dispensing under pressure; 3) dispensing in a restricted space or environment; and, 4) managing external influences. To identify and evaluate risks effectively, an approach that includes understanding relationships between key components in dispensing is required. Since teams of people in community pharmacies are a key dispensing component, and therefore part of the operational process, it is important to note how they relate to other components in the environment within which they operate. Pharmacies can take the opportunity to reflect on the organization of their systems and review in particular how they can improve on the four key categories identified. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Numerical Simulation Analysis of High-precision Dispensing Needles for Solid-liquid Two-phase Grinding

NASA Astrophysics Data System (ADS)

Li, Junye; Hu, Jinglei; Wang, Binyu; Sheng, Liang; Zhang, Xinming

2018-03-01

In order to investigate the effect of abrasive flow polishing surface variable diameter pipe parts, with high precision dispensing needles as the research object, the numerical simulation of the process of polishing high precision dispensing needle was carried out. Analysis of different volume fraction conditions, the distribution of the dynamic pressure and the turbulence viscosity of the abrasive flow field in the high precision dispensing needle, through comparative analysis, the effectiveness of the abrasive grain polishing high precision dispensing needle was studied, controlling the volume fraction of silicon carbide can change the viscosity characteristics of the abrasive flow during the polishing process, so that the polishing quality of the abrasive grains can be controlled.

Preliminary Assessment of Spatial Competition in the Market for E85

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clinton, Bentley

Anecdotal evidence suggests retail E85 prices may track retail gasoline prices rather than wholesale costs. This indicates E85 prices may be higher than they would be if priced on a cost basis hence limiting adoption by some price-sensitive consumers. Using publicly available and proprietary E83 and regular gasoline price data, we examine pricing behavior in the market for E85. Specifically, we assess the extent to which local retail competition in E85 markets decreases E85 retail prices. Results of econometric analysis suggest that higher levels of retail competition (measured in terms of station density) are associated with lower E85 prices atmore » the pump. While more precise causal estimates may be produced from more comprehensive data, this study is the first to our knowledge that estimates the spatial competition dimension of E85 pricing behavior by firms. This is an initial presentation; a related technical report is also available.« less

Automated drug dispensing system reduces medication errors in an intensive care setting.

PubMed

Chapuis, Claire; Roustit, Matthieu; Bal, Gaëlle; Schwebel, Carole; Pansu, Pascal; David-Tchouda, Sandra; Foroni, Luc; Calop, Jean; Timsit, Jean-François; Allenet, Benoît; Bosson, Jean-Luc; Bedouch, Pierrick

2010-12-01

We aimed to assess the impact of an automated dispensing system on the incidence of medication errors related to picking, preparation, and administration of drugs in a medical intensive care unit. We also evaluated the clinical significance of such errors and user satisfaction. Preintervention and postintervention study involving a control and an intervention medical intensive care unit. Two medical intensive care units in the same department of a 2,000-bed university hospital. Adult medical intensive care patients. After a 2-month observation period, we implemented an automated dispensing system in one of the units (study unit) chosen randomly, with the other unit being the control. The overall error rate was expressed as a percentage of total opportunities for error. The severity of errors was classified according to National Coordinating Council for Medication Error Reporting and Prevention categories by an expert committee. User satisfaction was assessed through self-administered questionnaires completed by nurses. A total of 1,476 medications for 115 patients were observed. After automated dispensing system implementation, we observed a reduced percentage of total opportunities for error in the study compared to the control unit (13.5% and 18.6%, respectively; p<.05); however, no significant difference was observed before automated dispensing system implementation (20.4% and 19.3%, respectively; not significant). Before-and-after comparisons in the study unit also showed a significantly reduced percentage of total opportunities for error (20.4% and 13.5%; p<.01). An analysis of detailed opportunities for error showed a significant impact of the automated dispensing system in reducing preparation errors (p<.05). Most errors caused no harm (National Coordinating Council for Medication Error Reporting and Prevention category C). The automated dispensing system did not reduce errors causing harm. Finally, the mean for working conditions improved from 1.0±0.8 to 2.5±0.8 on the four-point Likert scale. The implementation of an automated dispensing system reduced overall medication errors related to picking, preparation, and administration of drugs in the intensive care unit. Furthermore, most nurses favored the new drug dispensation organization.

The E1 Protein of Human Papillomavirus Type 16 Is Dispensable for Maintenance Replication of the Viral Genome

PubMed Central

Egawa, Nagayasu; Nakahara, Tomomi; Ohno, Shin-ichi; Narisawa-Saito, Mako; Yugawa, Takashi; Fujita, Masatoshi; Yamato, Kenji; Natori, Yukikazu

2012-01-01

Papillomavirus genomes are thought to be amplified to about 100 copies per cell soon after infection, maintained constant at this level in basal cells, and amplified for viral production upon keratinocyte differentiation. To determine the requirement for E1 in viral DNA replication at different stages, an E1-defective mutant of the human papillomavirus 16 (HPV16) genome featuring a translation termination mutation in the E1 gene was used. The ability of the mutant HPV16 genome to replicate as nuclear episomes was monitored with or without exogenous expression of E1. Unlike the wild-type genome, the E1-defective HPV16 genome became established in human keratinocytes only as episomes in the presence of exogenous E1 expression. Once established, it could replicate with the same efficiency as the wild-type genome, even after the exogenous E1 was removed. However, upon calcium-induced keratinocyte differentiation, once again amplification was dependent on exogenous E1. These results demonstrate that the E1 protein is dispensable for maintenance replication but not for initial and productive replication of HPV16. PMID:22238312

How much are biosimilars used in southern Italy?: a retrospective analysis of epoetin utilization in the local health unit of Messina in the years 2010-2011.

PubMed

Loiacono, Chiara; Sgroi, Carmela; Coppolino, Salvatore; Cannata, Angelo; Ferrara, Rosarita; Arcoraci, Vincenzo; Cananzi, Pasquale; Savica, Vincenzo; Schuemie, Martijn; Caputi, Achille P; Trifirò, Gianluca

2012-04-01

Epoetins are one of the three biologics for which biosimilars are available in Italy. So far, there is a lack of Italian national/regional longitudinal data about epoetin use. The aim of this study was to evaluate the prescribing pattern of epoetins (reference products and biosimilars) in a Local Health Unit (LHU) of Southern Italy in recent years. A retrospective drug utilization study was conducted during the period 1 January 2010 - 31 May 2011. The data source was the dispensing database of the Messina LHU, which contains anonymized data about dispensed drugs (including epoetins) that are prescribed by specialists to the residents in the catchment area. Indication of use and prescribed dosage of epoetins were derived by the therapeutic plans filled in by specialists and linked to drug dispensing records. Prevalence of epoetin use in the province of Messina (653 810 inhabitants) in 2010 was calculated. Furthermore, frequency analyses by sex, age, indication of use of epoetin users, as well as measurement of volume of use (defined daily dose [DDD]/1000/day) and expenditure of epoetins in 2010 were also performed. Analysis of the switching pattern between different reference products and biosimilar epoetins was performed. Overall, 4288 patients were treated with epoetins during the study period (mean age  ± SD: 74.2 ± 13.7; females: 52%). Darbepoetin alpha and reference product epoetin alpha accounted overall for 79.8% of epoetin users, while biosimilars of epoetin alpha accounted for 0.9%. Among 1247 epoetin users for whom the therapeutic plan was revised, 1065 (85.4%) were treated because of anemia due to chronic kidney disease and 158 (12.6%) because of chemotherapy-induced anemia. In 2010, prevalence of epoetin use was 5.5 (95% CI 5.3, 5.7) per 1000 inhabitants in the province of Messina. The volume of use and related expenditure for epoetins was 3.58 DDD/1000 inhabitants/day and Euro 5 572 457 (about Euro 8.50 per capita/day) in 2010. Switching between different epoetins was very frequent (21.8% of users) but switching from reference products to biosimilars was very rare. Epoetins are frequently dispensed to residents in the province of Messina, mainly for the treatment of chronic kidney disease-related anemia, with a relevant impact on the pharmaceutical expenditure covered by the National Health System. Use of biosimilar products is very low in both naïve patients and in those who switch from other reference product epoetins.

Construction of a smart medication dispenser with high degree of scalability and remote manageability.

PubMed

Pak, JuGeon; Park, KeeHyun

2012-01-01

We propose a smart medication dispenser having a high degree of scalability and remote manageability. We construct the dispenser to have extensible hardware architecture for achieving scalability, and we install an agent program in it for achieving remote manageability. The dispenser operates as follows: when the real-time clock reaches the predetermined medication time and the user presses the dispense button at that time, the predetermined medication is dispensed from the medication dispensing tray (MDT). In the proposed dispenser, the medication for each patient is stored in an MDT. One smart medication dispenser contains mainly one MDT; however, the dispenser can be extended to include more MDTs in order to support multiple users using one dispenser. For remote management, the proposed dispenser transmits the medication status and the system configurations to the monitoring server. In the case of a specific event such as a shortage of medication, memory overload, software error, or non-adherence, the event is transmitted immediately. All these operations are performed automatically without the intervention of patients, through the agent program installed in the dispenser. Results of implementation and verification show that the proposed dispenser operates normally and performs the management operations from the medication monitoring server suitably.

Photonics and microarray technology

NASA Astrophysics Data System (ADS)

Skovsen, E.; Duroux, M.; Neves-Petersen, M. T.; Duroux, L.; Petersen, S. B.

2007-05-01

Photonic induced immobilization of biosensor molecules is a novel technology that results in spatially oriented and spatially localized covalent coupling of a large variety of biomolecules onto thiol reactive surfaces, e.g. thiolated glass, quartz, gold or silicon. The reaction mechanism behind the reported new technology involves light-induced breakage of disulphide bridges in proteins upon UV illumination of nearby aromatic amino acids resulting in the formation of reactive molecules that will form covalent bonds with thiol reactive surfaces. This new technology has the potential of replacing present micro dispensing arraying technologies, where the size of the individual sensor spots are limited by the size of the dispensed droplets. Using light-induced immobilization the spatial resolution is defined by the area of the sensor surface that is illuminated by UV light and not by the physical size of the dispensed droplets of sensor molecules. This new technology allows for dense packing of different biomolecules on a surface, allowing the creation of multi-potent functionalized materials, such as biosensors with micrometer sized individual sensor spots. Thus, we have developed the necessary technology for preparing large protein arrays of enzymes and fragments of antibodies, with micrometer resolution, without the need for liquid micro dispensing.

New Opioid Analgesic Approvals and Outpatient Utilization of Opioid Analgesics in the United States, 1997 through 2015.

PubMed

Chai, Grace; Xu, Jing; Osterhout, James; Liberatore, Mark A; Miller, Kathleen L; Wolff, Carolyn; Cruz, Marisa; Lurie, Peter; Dal Pan, Gerald

2018-05-01

The opioid epidemic, driven in part by increased prescribing, is a public health emergency. This study examines dispensed prescription patterns and approvals of new opioid analgesic products to investigate whether the introduction of these new drugs increases prescribing. Prescribing patterns based on dispensed prescription claims from the U.S. retail setting were assessed with new brand and generic opioid analgesic products approved in the United States from 1997 through 2015. From 1997 through 2015, the U.S. Food and Drug Administration (Silver Spring, Maryland) approved 263 opioid analgesic products, including 33 brand products. Dispensed prescriptions initially increased 80% from 145 million prescriptions in 1997 to a peak of 260 million prescriptions in 2012 before decreasing by 12% to 228 million prescriptions in 2015. Morphine milligram equivalents dispensed per prescription increased from 486 in 1997 to a peak of 950 in 2010, before decreasing to 905 in 2015. In 2015, generic products accounted for 96% (218/228 million prescriptions) of all opioid analgesic prescriptions dispensed. The remaining prescriptions were dispensed for brand products, of which nearly half were dispensed for one brand product (OxyContin, Purdue, USA). There has been a dramatic increase in prescriptions dispensed for opioid analgesics since 1997 and an increasing number of opioid analgesic approvals; however, the number of prescriptions dispensed has declined since 2012 despite an increasing number of approvals. Examination of dispensed prescriptions shows a shifting and complex market where multiple factors likely influence prescribing; the approval of new products alone may not be sufficient to be a primary driver of increased prescribing. An online visual overview is available for this article at http://links.lww.com/ALN/B705.

Do WiFi-based hand hygiene dispenser systems increase hand hygiene compliance?

PubMed

Scheithauer, Simone; Bickenbach, Johannes; Heisel, Hans; Fehling, Patrick; Marx, Gernot; Lemmen, Sebastian

2018-05-17

Innovative methods to ensure better compliance in hand hygiene are urgently needed. The aim of this study was to determine if WiFi-based hand hygiene dispenser-driven self-assessment systems (Wireless Fidelity, WiFi-dispenser) can support the work of infection control teams. Our results suggest that the continuous monitoring of dispenser usage can be a valuable addition to infection prevention and control programs, when used in a bundle in combination with conventional hand hygiene training. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Hand sanitizer-dispensing door handles increase hand hygiene compliance: a pilot study.

PubMed

Babiarz, Lukasz S; Savoie, Brent; McGuire, Mark; McConnell, Lauren; Nagy, Paul

2014-04-01

Improving rates of hand hygiene compliance (HHC) has been shown to reduce nosocomial disease. We compared the HHC for a traditional wall-mounted unit and a novel sanitizer-dispensing door handle device in a hospital inpatient ultrasound area. HHC increased 24.5%-77.1% (P < .001) for the exam room with the sanitizer-dispensing door handle, whereas it remained unchanged for the other rooms. Technical improvements like a sanitizer-dispensing door handle can improve hospital HHC. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Gout and the Risk of Non-vertebral Fracture

PubMed Central

Kim, Seoyoung C.; Paik, Julie M.; Liu, Jun; Curhan, Gary C.; Solomon, Daniel H.

2016-01-01

Prior studies suggest an association between osteoporosis, systemic inflammation and pro-inflammatory cytokines such as IL-1 and IL-6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004–2013), we evaluated the risk of non-vertebral fracture (i.e. forearm, wrist, hip and pelvis) in patients with gout versus those without. Gout patients were identified with ≥2 diagnosis codes and ≥1 dispensing for a gout-related drug. Non-gout patients, identified with ≥2 visits coded for any diagnosis and ≥1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout-related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non-vertebral fracture in gout patients versus non-gout, adjusting for over 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non-vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non-gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2-year follow-up, the incidence rate of non-vertebral fracture per 1,000 person-years was 2.92 in gout and 2.66 in non-gout. The adjusted hazard ratio (HR) was 0.98 (95%CI 0.85–1.12) for non-vertebral fracture and 0.83 (95%CI 0.65–1.07) for hip fracture in gout versus non-gout. Subgroup analysis (n=15,079) showed no association between baseline sUA and non-vertebral fracture (HR 1.03, 95%CI 0.93–1.15), adjusted for age, sex, comorbidity score and number of any prescription drugs. Gout was not associated with a risk of non-vertebral fracture. Among patients with gout, sUA was not associated with the risk of non-vertebral fracture. PMID:27541696

Willingness to pay for a pharmacist’s dispensing service: a cross-sectional pilot study in the state of Penang, Malaysia

PubMed Central

Shafie, Asrul A.; Hassali, Mohamed A.

2009-01-01

Objective The aim of this pilot study was to assess the value of the dispensing service of pharmacists from the general public’s perspective using the contingent valuation technique in the State of Penang, Malaysia. Methods Participants were conveniently sampled from malls and were given a self-completed questionnaire that collected the patient’s demographic information and their knowledge about the pharmacist’s dispensing service. They were then presented with a description of the pharmacist’s dispensing service, the risk of medication errors in prescriptions and their consequences, and the risk reduction of medication errors associated with pharmacist intervention. The willingness to pay (WTP) of the participants was later assessed using a contingent valuation interview that asked the likelihood and maximum amount they were willing to pay. Results In the study, 100 people participated, and 57% were aged between 18 and 35 years. Of these participants, 51% were women, and 46% of them earned more than 1000 MYR (285.71USD) per month. In addition, 8% of the participants had never visited a community pharmacy. Finally, 67% of the participants were willing to pay for the pharmacists’ dispensing service, and the median amount that the participants were willing to pay was 10 MYR (2.86USD). The WTP amount was moderately correlated with their knowledge of the community pharmacist’s dispensing services (r=0.377, p=0.02). Conclusion Generally, the public valued the pharmacist’s dispensing service. Their acceptance can be further improved by educating the public on the role of the pharmacist. PMID:25132879

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM - Services data.

PubMed

Leite, Silvana Nair; Manzini, Fernanda; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mário; Farias, Mareni Rocha

2017-11-13

To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.

Cross Contamination: Are Hospital Gloves Reservoirs for Nosocomial Infections?

PubMed

Moran, Vicki; Heuertz, Rita

2017-01-01

Use of disposable nonsterile gloves in the hospital setting is second only to proper hand washing in reducing contamination during patient contact. Because proper handwashing is not consistently practiced, added emphasis on glove use is warranted. There is a growing body of evidence that glove boxes and dispensers available to healthcare workers are contaminated by daily exposure to environmental organisms. This finding, in conjunction with new and emerging antibiotic-resistant bacteria, poses a threat to patients and healthcare workers alike. A newly designed glove dispenser may reduce contamination of disposable gloves. The authors investigated contamination of nonsterile examination gloves in an Emergency Department setting according to the type of dispenser used to access gloves. A statistically significant difference existed between the number of bacterial colonies and the type of dispenser: the downward-facing glove dispenser had a lower number of bacteria on the gloves. There was no statistically significant difference in the number of gloves contaminated between the two types of glove dispensers. The study demonstrated that contamination of disposable gloves existed. Additional research using a larger sample size would validate a difference in the contamination of disposable gloves using outward or downward glove dispensers.

Understanding private retail drug outlet dispenser knowledge and practices in tuberculosis care in Tanzania.

PubMed

Rutta, E; Tarimo, A; Delmotte, E; James, I; Mwakisu, S; Kasembe, D; Konduri, N; Silumbe, R; Kakanda, K; Valimba, R

2014-09-01

Private sector accredited drug dispensing outlets in Morogoro and pharmacies in Dar es Salaam, Tanzania. To assess 1) the level of knowledge about tuberculosis (TB) among dispensers in Tanzania's retail pharmaceutical sector; 2) practices related to identification of patients with suspected TB; 3) the availability of educational materials and training; and 4) the availability of first- and second-line anti-tuberculosis treatment in retail drug outlets. A cross-sectional descriptive study involving the administration of a structured questionnaire among drug dispensers in 122 pharmacies and 173 accredited drug dispensing outlets. Private retail drug outlets are convenient; most are open at least 12 h per day, 7 days/week. Although 95% of dispensers identified persistent cough as a symptom of TB, only 1% had received TB-related training in the previous 3 years; 8% of outlets stocked first-line anti-tuberculosis medicines, which are legally prohibited from being sold at retail outlets. The majority of respondents reported seeing clients with TB-like symptoms, and of these 95% reported frequently referring clients to nearby health facilities. Private retail pharmaceutical outlets can potentially contribute to TB case detection and treatment; however, a coordinated effort is needed to train dispensers and implement appropriate referral procedures.

The impact of dispensing fees on compliance with opioid substitution therapy: a mixed methods study

PubMed Central

2014-01-01

Background Opioid substitution therapy (OST) programs involve the dispensing of OST medicines to patients to address their dependence on heroin and/or other opioid substances. OST medicines are subsidised by the Australian government but patients need to pay the dispensing fees. This study explored opinions from OST patients and stakeholders about the potential impact of dispensing fees on compliance and OST program retention. Current and past experiences and the potential impact of OST dispensing fees were evaluated. Methods Mixed methodology was used to obtain data from OST patients and stakeholders. This involved 1) interviews with OST stakeholders, 2) a focus group of OST patients and 3) surveys of OST patients in Perth, Australia, between June and August 2013. Results The majority of the eight stakeholders declared cost as the factor mostly impacting on OST compliance. Almost all of the stakeholders commented that there was a positive correlation between time on the OST program and success in terms of relapse. Most stakeholders advocated for OST fees to contribute towards the Pharmaceutical Benefits Scheme Safety Net, and for fee subsidy. Focus group themes supported stakeholder interview findings. A total of 138 surveys were completed. Survey analysis illustrated a strong correlation between patient debt and impacted lifestyle: 82.4% (p < 0.001, Chi-square test) of the 138 survey participants stated that dispensing fees impacted significantly on patients’ finances and lifestyle, specifically those patients with major debt. The cost of dispensing fees was identified by 46.3% (64/138) of survey participants as the biggest impacting factor on patient success. Logistic regression models showed that the cost of dispensing fees was also found to significantly influence both the occurrence of debt (57.7%, p < 0.0001) and lifestyle difficulties (80.0%, p = 0.0004). Conclusion Findings provided insight into OST patients’ financial difficulties with data suggesting that dispensing fees are likely to have a negative impact on OST patients’ compliance with therapy, retention in the OST program and lifestyle. Government sponsorship of the OST dispensing fees should be considered as sponsorship would potentially increase the retention rates of income-poor OST program recipients. PMID:25108396

The impact of dispensing fees on compliance with opioid substitution therapy: a mixed methods study.

PubMed

Shepherd, Alexandra; Perrella, Bianca; Hattingh, Hendrika Laetitia

2014-08-10

Opioid substitution therapy (OST) programs involve the dispensing of OST medicines to patients to address their dependence on heroin and/or other opioid substances. OST medicines are subsidised by the Australian government but patients need to pay the dispensing fees. This study explored opinions from OST patients and stakeholders about the potential impact of dispensing fees on compliance and OST program retention. Current and past experiences and the potential impact of OST dispensing fees were evaluated. Mixed methodology was used to obtain data from OST patients and stakeholders. This involved 1) interviews with OST stakeholders, 2) a focus group of OST patients and 3) surveys of OST patients in Perth, Australia, between June and August 2013. The majority of the eight stakeholders declared cost as the factor mostly impacting on OST compliance. Almost all of the stakeholders commented that there was a positive correlation between time on the OST program and success in terms of relapse. Most stakeholders advocated for OST fees to contribute towards the Pharmaceutical Benefits Scheme Safety Net, and for fee subsidy. Focus group themes supported stakeholder interview findings. A total of 138 surveys were completed. Survey analysis illustrated a strong correlation between patient debt and impacted lifestyle: 82.4% (p < 0.001, Chi-square test) of the 138 survey participants stated that dispensing fees impacted significantly on patients' finances and lifestyle, specifically those patients with major debt. The cost of dispensing fees was identified by 46.3% (64/138) of survey participants as the biggest impacting factor on patient success. Logistic regression models showed that the cost of dispensing fees was also found to significantly influence both the occurrence of debt (57.7%, p < 0.0001) and lifestyle difficulties (80.0%, p = 0.0004). Findings provided insight into OST patients' financial difficulties with data suggesting that dispensing fees are likely to have a negative impact on OST patients' compliance with therapy, retention in the OST program and lifestyle. Government sponsorship of the OST dispensing fees should be considered as sponsorship would potentially increase the retention rates of income-poor OST program recipients.

Randomized crossover study evaluating the effect of a hand sanitizer dispenser on the frequency of hand hygiene among anesthesiology staff in the operating room.

PubMed

Munoz-Price, L Silvia; Patel, Zalak; Banks, Shawn; Arheart, Kristopher; Eber, Scott; Lubarsky, David A; Birnbach, David J

2014-06-01

Forty anesthesia providers were evaluated with and without hand sanitizer dispensers present on the anesthesia machine. Having a dispenser increased the frequency of hand hygiene only from 0.5 to 0.8 events per hour (P = .01). Other concomitant interventions are needed to further increase hand hygiene frequency among anesthesia providers.

Small-Portion Water Dispenser

NASA Technical Reports Server (NTRS)

Joerns, J. C.

1986-01-01

Pressure regulated and flow timed to control amount dispensed. Dispenser provides measured amount of water for reconstituting dehydrated foods and beverages. Dispenser holds food or beverage package while being filled with either cold or room-temperature water. Other uses might include dispensing of fluids or medicine. Pressure regulator in dispenser reduces varying pressure of water supply to constant pressure. Electronic timer stops flow after predetermined length of time. Timed flow at regulated pressure ensures controlled volume of water dispensed.

Methodological challenges in assessment of current use of warfarin among patients with atrial fibrillation using dispensation data from administrative health care databases.

PubMed

Sinyavskaya, Liliya; Matteau, Alexis; Johnson, Sarasa; Durand, Madeleine

2018-06-05

Algorithms to define current exposure to warfarin using administrative data may be imprecise. Study objectives were to characterize dispensation patterns, to measure gaps between expected and observed refill dates for warfarin and direct oral anticoagulants (DOACs). Retrospective cohort study using administrative health care databases of the Régie de l'assurance-maladie du Québec. We identified every dispensation of warfarin, dabigatran, rivaroxaban, or apixaban for patients with AF initiating oral anticoagulants between 2010 and 2015. For each dispensation, we extracted date and duration. Refill gaps were calculated as difference between expected and observed dates of successive dispensation. Refill gaps were summarized using descriptive statistics. To account for repeated observations nested within patients and to assess the components of variance of refill gaps, we used unconditional multilevel linear models. We identified 61 516 new users. Majority were prescribed warfarin (60.3%), followed by rivaroxaban (16.4%), dabigatran (14.5%), apixaban (8.8%). Most frequent recorded duration of dispensation was 7 days, suggesting use of pharmacist-prepared weekly pillboxes. The average refill gap from multilevel model was higher for warfarin (9.28 days, 95%CI:8.97-9.59) compared with DOACs (apixaban 3.08 days, 95%CI: 2.96-3.20, dabigatran 3.70, 95%CI: 3.56-3.84, rivaroxaban 3.15, 95%CI: 3.03-3.27). The variance of refill gaps was greater among warfarin users than among DOAC users. Greater refill gaps for warfarin may reflect inadequate capture of the period covered by the number of dispensed pills recorded in administrative data. A time-dependent definition of exposure using dispensation data would lead to greater misclassification of warfarin than DOACs use. Copyright © 2018 John Wiley & Sons, Ltd.

Structure and function of POTRA domains of Omp85/TPS superfamily.

PubMed

Simmerman, Richard F; Dave, Ashita M; Bruce, Barry D

2014-01-01

The Omp85/TPS (outer-membrane protein of 85 kDa/two-partner secretion) superfamily is a ubiquitous and major class of β-barrel proteins. This superfamily is restricted to the outer membranes of gram-negative bacteria, mitochondria, and chloroplasts. The common architecture, with an N-terminus consisting of repeats of soluble polypeptide-transport-associated (POTRA) domains and a C-terminal β-barrel pore is highly conserved. The structures of multiple POTRA domains and one full-length TPS protein have been solved, yet discovering roles of individual POTRA domains has been difficult. This review focuses on similarities and differences between POTRA structures, emphasizing POTRA domains in autotrophic organisms including plants and cyanobacteria. Unique roles, specific for certain POTRA domains, are examined in the context of POTRA location with respect to their attachment to the β-barrel pore, and their degree of biological dispensability. Finally, because many POTRA domains may have the ability to interact with thousands of partner proteins, possible modes of these interactions are also explored. © 2014 Elsevier Inc. All rights reserved.

Application of concentration ratios to analyze the phenomenon of "next-door" pharmacy in Taiwan.

PubMed

Ji Chen, Tzeng; Chou, Li-Fang; Hwang, Shinn Jang

2006-08-01

In Taiwan, a policy of separation of prescribing and dispensing practices of practitioners at Western medical and dental clinics was implemented on an incremental basis in 1997. The purpose of this policy was to promote pharmacists' autonomy and increase the transparency and safety of prescribing medications. To avoid profit loss from no longer being able to dispense prescription medications, some clinics opened pharmacies located under the same roof as the clinic ("next-door" pharmacies) or hired an on-site pharmacist. This practice might compromise pharmacists' professional autonomy and patients' benefit in pharmaceutical care. The aim of the current study was to clarify the relationship between practicing pharmacies and clinics that resulted from contracts between pharmacies and the Bureau of National Health Insurance from 1996 to 2004. The National Health Research Institutes database in Taiwan supplied the complete claims data sets of practicing pharmacies from 1997 to 2004. The prescribing source of every dispensed prescription was used to calculate the 1-firm concentration ratio (CR-1) (ie, the proportion of prescriptions issued by the largest prescribing clinic/hospital in the total number of dispensed prescriptions of a pharmacy in each year). Similar processing was applied to the clinics. We identified each clinic's largest cooperating pharmacy and compared their CR-1s. Pharmacies that dispensed >900 prescriptions/mo during the study period were considered thriving. Pharmacies with a CR-1 > or =0.99 and whose largest cooperating clinic had a CR-1 > or =0.99 were considered to have a close business relationship, possibly indicating a next-door pharmacy. The total number of prescriptions dispensed at all pharmacies in the database grew from 226,901 in 1996 to 59,785,039 in 2004, and the number of pharmacies, from 481 to 3529. An increasing number of pharmacies had a higher CR-1 after 1999. We found that most prescriptions could be dispensed at only 1 pharmacy during the study period. In 2004, 1429 clinics had >900 prescriptions/mo dispensed externally and a CR-1 > or =0.99. They had released 75.8% of all prescriptions to be dispensed at practicing pharmacies; 811 of these clinics had a cooperating pharmacy with a CR-1 > or =0.99. In this data analysis in Taiwan, most prescriptions from practitioners at Western medical and dental clinics could be dispensed at only 1 pharmacy during the study period, suggesting that pharmacists' professional autonomy and the patients' benefit in pharmaceutical care might be compromised in Taiwan.

Can formalizing links among community health workers, accredited drug dispensing outlet dispensers, and health facility staff increase their collaboration to improve prompt access to maternal and child care? A qualitative study in Tanzania.

PubMed

Dillip, Angel; Kimatta, Suleiman; Embrey, Martha; Chalker, John C; Valimba, Richard; Malliwah, Mariam; Meena, John; Lieber, Rachel; Johnson, Keith

2017-06-19

In Tanzania, progress toward achieving the 2015 Millennium Development Goals for maternal and newborn health was slow. An intervention brought together community health workers, health facility staff, and accredited drug dispensing outlet (ADDO) dispensers to improve maternal and newborn health through a mechanism of collaboration and referral. This study explored barriers, successes, and promising approaches to increasing timely access to care by linking the three levels of health care provision. The study was conducted in the Kibaha district, where we applied qualitative approaches with in-depth interviews and focus group discussions. In-depth interview participants included retail drug shop dispensers (36), community health workers (45), and health facility staff members (15). We conducted one focus group discussion with district officials and four with mothers of newborns and children under 5 years old. Relationships among the three levels of care improved after the linkage intervention, especially for ADDO dispensers and health facility staff who previously had no formal communication pathway. The study participants perceptions of success included improved knowledge of case management and relationships among the three levels of care, more timely access to care, increased numbers of patients/customers, more meetings between community health workers and health facility staff, and a decrease in child and maternal mortality. Reported challenges included stock-outs of medicines at the health facility, participating ADDO dispensers who left to work in other regions, documentation of referrals, and lack of treatment available at health facilities on the weekend. The primary issue that threatens the sustainability of the intervention is that local council health management team members, who are responsible for facilitating the linkage, had not made any supervision visits and were therefore unaware of how the program was running. The study highlights the benefits of approaches that link different levels of care providers to improve access to maternal and child health care. To strengthen this collaboration further, health campaign platforms should include retail drug dispensers as a type of community health care provider. To increase linkage sustainability, the council health management team needs to develop feasible supervision plans.

Piezo- and solenoid valve-based liquid dispensing for miniaturized assays.

PubMed

Niles, Walter D; Coassin, Peter J

2005-04-01

Miniaturization of biological assays requires dispensing liquids in the submicroliter range of volumes. Accuracy and reproducibility of dispensing this range depend on both the dispenser and the receptacle in which the assay is constructed. Miniaturization technologies developed by Aurora Discovery, Inc. (San Diego, CA) include high-density multiwell plates for assay samples and reagent storage, as well as piezo-based and solenoid valve-based liquid dispensers. Some basic principles of small-volume dispensing by jetting are described to provide context for dispenser design and function. Performance of the latest instruments incorporating these dispensing devices is presented.

[Education and use of drugs in Norway].

PubMed

Hjellvik, Vidar; Mahic, Milada; Tverdal, Aage

2012-10-16

Many studies have demonstrated that a low socioeconomic status is associated with poor health. The aim of the study was to investigate whether use of prescription drugs, generally and within selected categories, varies with education. Data on education from the 2001 Population and Housing Census for 645,023 men and women born in the period 1960-1969 and living in Norway in 2001 were linked to data from the Norwegian Prescription Database on drugs dispensed in the period 2004-2009. The overall frequency of drug dispensing was compared with six levels of education. The relative risk associated with limited education (≤ 10 years) compared with long education (> 10 years) of having at least one drug dispensed during the period was calculated for 42 selected drug categories. There was a dose-response relationship between education and the number of drug prescriptions dispensed. Subjects with lower secondary education collected prescription drugs about three times as often on average as subjects with researcher education. The average relative risk of drug dispensing for subjects with short education (≤ 10 years) compared with long (>10 years) for the 42 selected drug categories was 1.29 for men and 1.31 for women. Given that dispensing of drugs is an expression of state of health, our findings support earlier studies that have shown that there is social inequality in the health of the adult population.

Effect of E85 on Tailpipe Emissions from Light-Duty Vehicles.

PubMed

Yanowitz, Janet; McCormick, Robert L

2009-02-01

E85, which consists of nominally 85% fuel grade ethanol and 15% gasoline, must be used in flexible-fuel (or "flex-fuel") vehicles (FFVs) that can operate on fuel with an ethanol content of 0-85%. Published studies include measurements of the effect of E85 on tailpipe emissions for Tier 1 and older vehicles. Car manufacturers have also supplied a large body of FFV certification data to the U.S. Environmental Protection Agency, primarily on Tier 2 vehicles. These studies and certification data reveal wide variability in the effects of E85 on emissions from different vehicles. Comparing Tier 1 FFVs running on E85 to similar non-FFVs running on gasoline showed, on average, significant reductions in emissions of oxides of nitrogen (NO x ; 54%), non-methane hydrocarbons (NMHCs; 27%), and carbon monoxide (CO; 18%) for E85. Comparing Tier 2 FFVs running on E85 and comparable non-FFVs running on gasoline shows, for E85 on average, a signifi-cant reduction in emissions of CO (20%), and no signifi-cant effect on emissions of non-methane organic gases (NMOGs). NO x emissions from Tier 2 FFVs averaged approximately 28% less than comparable non-FFVs. However, perhaps because of the wide range of Tier 2 NO x standards, the absolute difference in NO x emissions between Tier 2 FFVs and non-FFVs is not significant (P =0.28). It is interesting that Tier 2 FFVs operating on gasoline produced approximately 13% less NMOGs than non-FFVs operating on gasoline. The data for Tier 1 vehicles show that E85 will cause significant reductions in emissions of benzene and butadiene, and significant increases in emissions of formaldehyde and acetaldehyde, in comparison to emissions from gasoline in both FFVs and non-FFVs. The compound that makes up the largest proportion of organic emissions from E85-fueled FFVs is ethanol.

[Quality evaluation of rhubarb dispensing granules based on multi-component simultaneous quantitative analysis and bioassay].

PubMed

Tan, Peng; Zhang, Hai-Zhu; Zhang, Ding-Kun; Wu, Shan-Na; Niu, Ming; Wang, Jia-Bo; Xiao, Xiao-He

2017-07-01

This study attempts to evaluate the quality of Chinese formula granules by combined use of multi-component simultaneous quantitative analysis and bioassay. The rhubarb dispensing granules were used as the model drug for demonstrative study. The ultra-high performance liquid chromatography (UPLC) method was adopted for simultaneously quantitative determination of the 10 anthraquinone derivatives (such as aloe emodin-8-O-β-D-glucoside) in rhubarb dispensing granules; purgative biopotency of different batches of rhubarb dispensing granules was determined based on compound diphenoxylate tablets-induced mouse constipation model; blood activating biopotency of different batches of rhubarb dispensing granules was determined based on in vitro rat antiplatelet aggregation model; SPSS 22.0 statistical software was used for correlation analysis between 10 anthraquinone derivatives and purgative biopotency, blood activating biopotency. The results of multi-components simultaneous quantitative analysisshowed that there was a great difference in chemical characterizationand certain differences inpurgative biopotency and blood activating biopotency among 10 batches of rhubarb dispensing granules. The correlation analysis showed that the intensity of purgative biopotency was significantly correlated with the content of conjugated anthraquinone glycosides (P<0.01), and the intensity of blood activating biopotency was significantly correlated with the content of free anthraquinone (P<0.01). In summary, the combined use of multi-component simultaneous quantitative analysis and bioassay can achieve objective quantification and more comprehensive reflection on overall quality difference among different batches of rhubarb dispensing granules. Copyright© by the Chinese Pharmaceutical Association.

A simple low-cost of liquid I-131 dispenser for routine radiopharmaceutical dispensing at nuclear medicine department, Institut Kanser Negara

NASA Astrophysics Data System (ADS)

Said, M. A.; Ashhar, Z. N.; Suhaimi, N. E. F.; Zainon, R.

2016-01-01

In routine radiopharmaceutical Iodine-131 (131I) dispensing, the amount of radiation dose received by the personnel depends on the distance between the personnel and the source, the time spent manipulating the source and the amount of shielding used to reduce the dose rate from the source. The novel iRAD-I131 dispenser using recycle 131I liquid lead pot will lead into low cost production, less maintenance and low dose received by the personnel that prepared the 131I. The new fabricated of low cost 131I dispenser was tested and the dose received by personnel were evaluated. The body of lead material is made from 2.5 cm lead shielded coated with epoxy paint to absorb the radiation dose up to 7.4 GBq of 131 I. The lead pot was supported with two stainless steel rod. The Optically Stimulated Luminescence (OSL) nanodot was used in this study to measure the dose rate at both extremities for every personnel who prepared the 131I. Each OSL nanodot was attached at the fingertip. Three different personnel (experienced between one to ten years above in preparing the radiopharmaceuticals) were participated in this study. The average equivalent dose at right and left hand were 122.694 ± 121.637 µSv/GBq and 77.281 ± 62.146 µSv/GBq respectively. This study found that the dose exposure received using iRAD-I131 was less up to seven times compared to the conventional method. The comparison of experimental data using iRAD-I131 and established radiopharmaceutical dispenser was also discussed. The innovation of 131I dispenser is highly recommended in a small radiopharmaceutical facility with limited budget. The novel iRAD-I131 enables implementation of higher output liquid dispensing with low radiation dose to the personnel.

A simple low-cost of liquid I-131 dispenser for routine radiopharmaceutical dispensing at nuclear medicine department, Institut Kanser Negara

DOE Office of Scientific and Technical Information (OSTI.GOV)

Said, M. A.; Suhaimi, N. E. F.; Ashhar, Z. N., E-mail: aminhpj@gmail.com

In routine radiopharmaceutical Iodine-131 ({sup 131}I) dispensing, the amount of radiation dose received by the personnel depends on the distance between the personnel and the source, the time spent manipulating the source and the amount of shielding used to reduce the dose rate from the source. The novel iRAD-I131 dispenser using recycle {sup 131}I liquid lead pot will lead into low cost production, less maintenance and low dose received by the personnel that prepared the {sup 131}I. The new fabricated of low cost {sup 131}I dispenser was tested and the dose received by personnel were evaluated. The body of leadmore » material is made from 2.5 cm lead shielded coated with epoxy paint to absorb the radiation dose up to 7.4 GBq of {sup 131} I. The lead pot was supported with two stainless steel rod. The Optically Stimulated Luminescence (OSL) nanodot was used in this study to measure the dose rate at both extremities for every personnel who prepared the {sup 131}I. Each OSL nanodot was attached at the fingertip. Three different personnel (experienced between one to ten years above in preparing the radiopharmaceuticals) were participated in this study. The average equivalent dose at right and left hand were 122.694 ± 121.637 µSv/GBq and 77.281 ± 62.146 µSv/GBq respectively. This study found that the dose exposure received using iRAD-I131 was less up to seven times compared to the conventional method. The comparison of experimental data using iRAD-I131 and established radiopharmaceutical dispenser was also discussed. The innovation of {sup 131}I dispenser is highly recommended in a small radiopharmaceutical facility with limited budget. The novel iRAD-I131 enables implementation of higher output liquid dispensing with low radiation dose to the personnel.« less

[Incidence of hip fractures due to osteoporosis in relation to the prescription of drugs for their prevention and treatment in Galicia, Spain].

PubMed

Guerra-García, María Mercedes; Rodríguez-Fernández, José Benito; Puga-Sarmiento, Elías; Charle-Crespo, María Ángeles; Gomes-Carvalho, Claudia Sofía; Prejigueiro-Santás, Ana

2011-02-01

To analyse the evolution in the incidence of hip fractures in our autonomous community in relationship to the trend in the prescription of medicines for the prevention and/or treatment of osteoporotic hip fracture. Descriptive observational ecological study. Public health network in the whole autonomous community over five years, from 1st January 2004 to 31st December 2008. Patients over 44 years old admitted with osteoporotic hip fracture. Medicines dispensed at a pharmacy which are indicated for the prevention of osteoporotic hip fractures (alendronate, risedronate and strontium ranelate). Exclusion: Open fractures, hospital or private or prescriptions. Incidence (number of new cases of hip fractures occurring in a year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants) and Hazard ratio (HR, ratio between the rate of last year and first). Annual rates were calculated standardised by the direct method. We identified 12,137 hospital admissions for fractured hip (2,792 men and 9,345 women). Sub-capital fractures: Mean Incidence Rate (MIR)=86.14,95%CI[61.85-110.42]; HR=1.22, 95%CI[0.82-1.63] (men) and MIR=180.88,95%CI[124.74-237.02]; HR=1.08,95%CI[0.73-1.43] (women). Trochanteric fractures: MIR=56.30,95%CI[39.18-73.42], HR=1.04,95%CI[0.75-1.34] (men) and MIR=136.51,95%CI[90.23-182.78]; HR=1.12,95%CI[0.89-1.35] (women). Subtrochanteric fractures: MIR=8.92,95%CI[6.52-11.32]; HR=1.26,95%CI[0.05-2.46] (men) and MIR=22.91,95%CI[15.24-30.58]; HR=1.08,95%CI[0.57-1.58] (women). Total HR fractures=1.07, 95%CI[0.92-1.23] (men) and 0.99,95%CI[0.83-1.17] (women). Drug dispensing (2008-2004): HR alendronate=1.30; HR risedronate=1.92; HR strontium ranelate=10.38. Over five years the dispensing of drugs by the public health service has multiplied for the prevention and treatment of hip fractures while the incidence has remained unaltered. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Development of an Automatic Dispensing System for Traditional Chinese Herbs.

PubMed

Lin, Chi-Ying; Hsieh, Ping-Jung

2017-01-01

The gathering of ingredients for decoctions of traditional Chinese herbs still relies on manual dispensation, due to the irregular shape of many items and inconsistencies in weights. In this study, we developed an automatic dispensing system for Chinese herbal decoctions with the aim of reducing manpower costs and the risk of mistakes. We employed machine vision in conjunction with a robot manipulator to facilitate the grasping of ingredients. The name and formulation of the decoction are input via a human-computer interface, and the dispensing of multiple medicine packets is performed automatically. An off-line least-squared curve fitting method was used to calculate the amount of material grasped by the claws and thereby improve system efficiency as well as the accuracy of individual dosages. Experiments on the dispensing of actual ingredients demonstrate the feasibility of the proposed system.

Comparative Effectiveness of Biosimilar, Reference Product and Other Erythropoiesis-Stimulating Agents (ESAs) Still Covered by Patent in Chronic Kidney Disease and Cancer Patients: An Italian Population-Based Study.

PubMed

Ingrasciotta, Ylenia; Giorgianni, Francesco; Marcianò, Ilaria; Bolcato, Jenny; Pirolo, Roberta; Chinellato, Alessandro; Ientile, Valentina; Santoro, Domenico; Genazzani, Armando A; Alibrandi, Angela; Fontana, Andrea; Caputi, Achille P; Trifirò, Gianluca

2016-01-01

Since 2007 biosimilars of erythropoiesis-stimulating agents (ESAs) are available on the Italian market. Very limited post-marketing data exist on the comparative effectiveness of biosimilar and originator ESAs. This population-based study was aimed to compare the effects of biosimilars, reference product and other ESAs still covered by patent on hemoglobinemia in chronic kidney disease (CKD) and cancer patients in a Local Health Unit (LHU) from Northern Italy. A retrospective cohort study was conducted during the years 2009-2014 using data from Treviso LHU administrative database. Incident ESA users (no ESA dispensing within 6 months prior to treatment start, i.e. index date (ID)) with at least one hemoglobin measurement within one month prior to ID (baseline Hb value) and another measurement between 2nd and 3rd month after ID (follow-up Hb value) were identified. The strength of the consumption (as total number of defined daily dose (DDD) dispensed during the follow-up divided by days of follow-up) and the difference between follow-up and baseline Hb values [delta Hb (ΔHb)] were evaluated. Based on Hb changes, ESA users were classified as non-responders (ΔHb≤0 g/dl), responders (0<ΔHb≤2 g/dl), and highly responders (ΔHb>2 g/dl). A multivariate ordinal logistic regression model to identify predictors for responsiveness to treatment was performed. All analyses were stratified by indication for use and type of dispensed ESA at ID. Overall, 1,003 incident ESA users (reference product: 252, 25.1%; other ESAs covered by patent: 303, 30.2%; biosimilars: 448, 44.7%) with CKD or cancer were eligible for the study. No statistically significant difference in the amount of dose dispensed during the follow-up among biosimilars, reference product and other ESAs covered by patent was found in both CKD and cancer. After three months from treatment start, all ESAs increased Hb values on average by 2g/dl. No differences in ΔHb as well as in frequency of non-responders, responders and highly responders among different types of ESAs were observed in both indications of use. Overall, around 15-20% of ESA users were non-responders. Strength of treatment, but no type of dispensed ESAs was found to be predictor of responsiveness to treatment. No difference on the effects on hemoglobinemia among users of either biosimilars or reference product or ESAs covered by patent was observed in a general population from Northern Italy, despite a comparable dispensed dose of the different ESAs during the first three months of treatment.

Renal Drug Dosing

PubMed Central

Vogel, Erin A.; Billups, Sarah J.; Herner, Sheryl J.

2016-01-01

Summary Objective The purpose of this study was to compare the effectiveness of an outpatient renal dose adjustment alert via a computerized provider order entry (CPOE) clinical decision support system (CDSS) versus a CDSS with alerts made to dispensing pharmacists. Methods This was a retrospective analysis of patients with renal impairment and 30 medications that are contraindicated or require dose-adjustment in such patients. The primary outcome was the rate of renal dosing errors for study medications that were dispensed between August and December 2013, when a pharmacist-based CDSS was in place, versus August through December 2014, when a prescriber-based CDSS was in place. A dosing error was defined as a prescription for one of the study medications dispensed to a patient where the medication was contraindicated or improperly dosed based on the patient’s renal function. The denominator was all prescriptions for the study medications dispensed during each respective study period. Results During the pharmacist- and prescriber-based CDSS study periods, 49,054 and 50,678 prescriptions, respectively, were dispensed for one of the included medications. Of these, 878 (1.8%) and 758 (1.5%) prescriptions were dispensed to patients with renal impairment in the respective study periods. Patients in each group were similar with respect to age, sex, and renal function stage. Overall, the five-month error rate was 0.38%. Error rates were similar between the two groups: 0.36% and 0.40% in the pharmacist- and prescriber-based CDSS, respectively (p=0.523). The medication with the highest error rate was dofetilide (0.51% overall) while the medications with the lowest error rate were dabigatran, fondaparinux, and spironolactone (0.00% overall). Conclusions Prescriber- and pharmacist-based CDSS provided comparable, low rates of potential medication errors. Future studies should be undertaken to examine patient benefits of the prescriber-based CDSS. PMID:27466041

Swans replacing filter in U.S. Laboratory

NASA Image and Video Library

2014-07-15

ISS040-E-064628 (15 July 2014) --- NASA astronaut Steve Swanson, Expedition 40 commander, replaces filters in the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station.

The socio-technical organisation of community pharmacies as a factor in the Electronic Prescription Service Release Two implementation: a qualitative study

PubMed Central

2012-01-01

Background The introduction of a new method of transmitting prescriptions from general practices to community pharmacies in England (Electronic Prescription Service Release 2 (EPS2)) has generated debate on how it will change work practice. As EPS2 will be a key technical element in dispensing, we reviewed the literature to find that there were no studies on how social and technical elements come together to form work practice in community pharmacies. This means the debate has little point of reference. Our aim therefore was to study the ways social and technical elements of a community pharmacy are used to achieve dispensing through the development of a conceptual model on pharmacy work practice, and to consider how a core technical element such the EPS2 could change work practice. Method We used ethnographic methods inclusive of case-study observations and interviews to collect qualitative data from 15 community pharmacies that were in the process of adopting or were soon to adopt EPS2. We analysed the case studies thematically and used rigorous multi-dimensional and multi-disciplinary interpretive validation techniques to cross analyse findings. Results In practice, dispensing procedures were not designed to take into account variations in human and technical integration, and assumed that repetitive and collective use of socio-technical elements were at a constant. Variables such as availability of social and technical resources, and technical know-how of staff were not taken into account in formalised procedures. Yet community pharmacies were found to adapt their dispensing in relation to the balance of social and technical elements available, and how much of the social and technical elements they were willing to integrate into dispensing. While some integrated as few technical elements as possible, some depended entirely on technical artefacts. This pattern also applied to the social elements of dispensing. Through the conceptual model development process, we identified three approaches community pharmacies used to appropriate procedures in practice. These were ‘technically oriented’, ‘improvising’ or ‘socially oriented’. Conclusion We offer a model of different work approaches community pharmacies use to dispense, which suggests that when adopting a core technical element such as the EPS2 system of dispensing there could be variations in its successful adoption. Technically oriented pharmacies might find it easiest to integrate a similar artefact into work practice although needs EPS2 to synchronise effectively with existing technologies. Pharmacies adopting an improvising-approach have the potential to improve how they organise dispensing through EPS2 although they will need to improve how they apply their operating procedures. Socially oriented pharmacies will need to dramatically adapt their approach to dispensing since they usually rely on few technical tools. PMID:23256484

The socio-technical organisation of community pharmacies as a factor in the Electronic Prescription Service Release Two implementation: a qualitative study.

PubMed

Harvey, Jasmine; Avery, Anthony J; Waring, Justin; Barber, Nick

2012-12-20

The introduction of a new method of transmitting prescriptions from general practices to community pharmacies in England (Electronic Prescription Service Release 2 (EPS2)) has generated debate on how it will change work practice. As EPS2 will be a key technical element in dispensing, we reviewed the literature to find that there were no studies on how social and technical elements come together to form work practice in community pharmacies. This means the debate has little point of reference. Our aim therefore was to study the ways social and technical elements of a community pharmacy are used to achieve dispensing through the development of a conceptual model on pharmacy work practice, and to consider how a core technical element such the EPS2 could change work practice. We used ethnographic methods inclusive of case-study observations and interviews to collect qualitative data from 15 community pharmacies that were in the process of adopting or were soon to adopt EPS2. We analysed the case studies thematically and used rigorous multi-dimensional and multi-disciplinary interpretive validation techniques to cross analyse findings. In practice, dispensing procedures were not designed to take into account variations in human and technical integration, and assumed that repetitive and collective use of socio-technical elements were at a constant. Variables such as availability of social and technical resources, and technical know-how of staff were not taken into account in formalised procedures. Yet community pharmacies were found to adapt their dispensing in relation to the balance of social and technical elements available, and how much of the social and technical elements they were willing to integrate into dispensing. While some integrated as few technical elements as possible, some depended entirely on technical artefacts. This pattern also applied to the social elements of dispensing. Through the conceptual model development process, we identified three approaches community pharmacies used to appropriate procedures in practice. These were 'technically oriented', 'improvising' or 'socially oriented'. We offer a model of different work approaches community pharmacies use to dispense, which suggests that when adopting a core technical element such as the EPS2 system of dispensing there could be variations in its successful adoption. Technically oriented pharmacies might find it easiest to integrate a similar artefact into work practice although needs EPS2 to synchronise effectively with existing technologies. Pharmacies adopting an improvising-approach have the potential to improve how they organise dispensing through EPS2 although they will need to improve how they apply their operating procedures. Socially oriented pharmacies will need to dramatically adapt their approach to dispensing since they usually rely on few technical tools.

What do Australian consumers, pharmacists and prescribers think about documenting indications on prescriptions and dispensed medicines labels?: A qualitative study.

PubMed

Garada, Mona; McLachlan, Andrew J; Schiff, Gordon D; Lehnbom, Elin C

2017-11-15

Documenting the indication on prescriptions and dispensed medicines labels is not standard practice in Australia. However, previous studies that have focused on the content and design of dispensed medicines labels, have suggested including the indication as a safety measure. The aim of this study was to investigate the perspectives of Australian consumers, pharmacists and prescribers on documenting the indication on prescriptions and dispensed medicines labels. Semi-structured interviews were conducted and mock-up of dispensed medicines labels were designed for participants. Consumers (n = 19) and pharmacists (n = 7) were recruited by convenience sample at community pharmacies in Sydney (Australia) and prescribers (n = 8), including two medical students, were recruited through snowballing. Thirty-four participants were interviewed. Most participants agreed that documenting the indication would be beneficial especially for patients who are forgetful or take multiple medications. Participants also believed it would improve consumers' medication understanding and adherence. Prescribers and pharmacists believed it could help reduce prescribing and dispensing errors by matching the drug/dosage to the correct indication. Prescribers refrained from documenting the indication to protect patients' privacy; however, most patients did not consider documenting the indication as a breach of privacy. Prescribers raised concerns about the extra time to include indications on prescriptions and best language to document indications, using plain language as opposed to medical terminology. All interviewed stakeholders identified numerous benefits of documenting the indication on prescriptions and dispensed medicines labels. Whether these potential benefits can be realized remains unknown and addressing prescribers' concern regarding the time involved in documenting the indication on prescriptions remains a challenge for vendors of electronic medication management systems.

Bacterial Hand Contamination and Transfer after Use of Contaminated Bulk-Soap-Refillable Dispensers▿†

PubMed Central

Zapka, Carrie A.; Campbell, Esther J.; Maxwell, Sheri L.; Gerba, Charles P.; Dolan, Michael J.; Arbogast, James W.; Macinga, David R.

2011-01-01

Bulk-soap-refillable dispensers are prone to extrinsic bacterial contamination, and recent studies demonstrated that approximately one in four dispensers in public restrooms are contaminated. The purpose of this study was to quantify bacterial hand contamination and transfer after use of contaminated soap under controlled laboratory and in-use conditions in a community setting. Under laboratory conditions using liquid soap experimentally contaminated with 7.51 log10 CFU/ml of Serratia marcescens, an average of 5.28 log10 CFU remained on each hand after washing, and 2.23 log10 CFU was transferred to an agar surface. In an elementary-school-based field study, Gram-negative bacteria on the hands of students and staff increased by 1.42 log10 CFU per hand (26-fold) after washing with soap from contaminated bulk-soap-refillable dispensers. In contrast, washing with soap from dispensers with sealed refills significantly reduced bacteria on hands by 0.30 log10 CFU per hand (2-fold). Additionally, the mean number of Gram-negative bacteria transferred to surfaces after washing with soap from dispensers with sealed-soap refills (0.06 log10 CFU) was significantly lower than the mean number after washing with contaminated bulk-soap-refillable dispensers (0.74 log10 CFU; P < 0.01). Finally, significantly higher levels of Gram-negative bacteria were recovered from students (2.82 log10 CFU per hand) than were recovered from staff (2.22 log10 CFU per hand) after washing with contaminated bulk soap (P < 0.01). These results demonstrate that washing with contaminated soap from bulk-soap-refillable dispensers can increase the number of opportunistic pathogens on the hands and may play a role in the transmission of bacteria in public settings. PMID:21421792

Qualitative and quantitative measures of various compounded formulations of 17-hydroxyprogesterone caproate

PubMed Central

CARITIS, Steve N.; ZHAO, Yang; BETTINGER, Joseph; VENKATARAMANAN, Raman

2013-01-01

Objectives 17-hydroxyprogesterone caproate (17-OHPC) is available both as an FDA – approved medication and as a product prepared for individual patients by compounding pharmacies. Compounding pharmacies may omit the preservative used in the FDA approved formulation or use an alternate preservative and may dispense 17-OHPC in containers that differ from the FDA-approved product. The objective of this study was to assess the stability, microbiological and pyrogen status of 17-OHPC formulations under various compounding and dispensing conditions. Methods 17-OHPC was prepared by a local compounding pharmacy. The formulations prepared included one identical to the FDA approved product with benzyl alcohol as a preservative, one with benzalkonium chloride as a preservative and one without a preservative. These various formulations were dispensed into either single dose 1 ml plastic syringes or glass vials or 10 ml glass vials. Concentration of 17-OHPC and microbial and pyrogen status were evaluated at various time intervals over the ensuing 19 weeks. Results The concentration of 17-OHPC did not change over the duration of study regardless of the dispensing medium used or the absence or presence of any preservatives. The preparations remained microbe and pyrogen free during the study period regardless of the dispensing medium used or the absence of presence of any preservatives. Conclusions Products containing 17-OPHC tested in this study were quite stable over the 19-week period of study in different dispensing containers and in absence or presence of a different preservative. The compounded products remained sterile and pyrogen free during the period of observation. PMID:23453884

Self-medication with antibiotics in the Republic of Srpska community pharmacies: pharmacy staff behavior.

PubMed

Marković-Peković, Vanda; Grubiša, Nataša

2012-10-01

Self-medication with antibiotics adds to the global risk of increased spread of bacterial resistance. Attitudes and behavior of health professionals also may reinforce self-medication with antibiotics. The aim of this study was to determine whether self-medication with antibiotics is possible in our community pharmacies and to what extent, and to evaluate the behavior and service of pharmacy health professionals regarding non-prescription antibiotic dispensation. An observational, cross-section study was conducted, and pseudo-patient methodology was used to establish the kind of professional service provided in case of patient's explicit demand to buy an antibiotic for treatment of self-diagnosed upper respiratory tract infection. Of the total 318 community pharmacies, 131 (41%) were visited and included in the study. Non-prescription antibiotics were dispensed in 76 (58%) pharmacies. Counseling and symptomatic therapy was offered in 88 (67%) pharmacies. In 25% of pharmacies, no symptomatic therapy was offered; instead, only an antibiotic was sold. Amoxicillin was sold in 85% of cases and, mostly, the one of 1.30 Euro per pack. Both oral and written use instructions were given in 78% cases, whereas none was given in 3% of cases. Self-medication with antibiotics occurs in our community pharmacies, despite being illegal. Pharmacy staff behavior can be a factor that puts patients at risk for self-medication with antibiotics. Community pharmacies are failing their tasks in enhancing rational use of antibiotics. Such a practice may be a consequence of weak enforcement and control over the legislation and professional standards. Copyright © 2012 John Wiley & Sons, Ltd.

System for Dispensing a Precise Amount of Fluid

DOEpatents

Benett, William J.; Krulevitch, Peter A.; Visuri, Steven R.; Dzenitis, John M.; Ness, Kevin D.

2008-08-12

A dispensing system delivers a precise amount of fluid for biological or chemical processing and/or analysis. Dispensing means moves the fluid. The dispensing means is operated by a pneumatic force. Connection means delivers the fluid to the desired location. An actuator means provides the pneumatic force to the dispensing means. Valving means transmits the pneumatic force from the actuator means to the dispensing means.

Centrifugal multiplexing fixed-volume dispenser on a plastic lab-on-a-disk for parallel biochemical single-end-point assays

PubMed Central

La, Moonwoo; Park, Sang Min; Kim, Dong Sung

2015-01-01

In this study, a multiple sample dispenser for precisely metered fixed volumes was successfully designed, fabricated, and fully characterized on a plastic centrifugal lab-on-a-disk (LOD) for parallel biochemical single-end-point assays. The dispenser, namely, a centrifugal multiplexing fixed-volume dispenser (C-MUFID) was designed with microfluidic structures based on the theoretical modeling about a centrifugal circumferential filling flow. The designed LODs were fabricated with a polystyrene substrate through micromachining and they were thermally bonded with a flat substrate. Furthermore, six parallel metering and dispensing assays were conducted at the same fixed-volume (1.27 μl) with a relative variation of ±0.02 μl. Moreover, the samples were metered and dispensed at different sub-volumes. To visualize the metering and dispensing performances, the C-MUFID was integrated with a serpentine micromixer during parallel centrifugal mixing tests. Parallel biochemical single-end-point assays were successfully conducted on the developed LOD using a standard serum with albumin, glucose, and total protein reagents. The developed LOD could be widely applied to various biochemical single-end-point assays which require different volume ratios of the sample and reagent by controlling the design of the C-MUFID. The proposed LOD is feasible for point-of-care diagnostics because of its mass-producible structures, reliable metering/dispensing performance, and parallel biochemical single-end-point assays, which can identify numerous biochemical. PMID:25610516

[Study on effect of 3 types of drinking water emergent disinfection models in flood/waterlog areas].

PubMed

Ban, Haiqun; Li, Jin; Li, Xinwu; Zhang, Liubo

2010-09-01

To establish 3 drinking water emergent disinfection processing models, separated medicate dispensing, specific duty medicate dispensing, and centralized filtering, in flood/waterlog areas, and compare the effects of these 3 models on the drinking water disinfection processing. From October to December, 2008, 18 villages were selected as the trial field in Yanglinwei town, Xiantao city, Hubei province, which were divided into three groups, separated medicate dispensing, specific duty medicate dispensing, and centralized filtering. Every 2 weeks, drinking water source water, yielding water of emergency central filtrate water equipment (ECFWE) and container water in the kitchen were sampled and microbe indices of the water sample, standard plate-count bacteria, total coliforms, thermotolerant coliform bacteria, Escherichia coli were measured. The microbe pollution of the water of these 3 water source groups are heavy, all failed. The eliminating rate of the standard plate-count bacteria of the drinking water emergent centralized processing equipment is 99.95%; those of the separate medicate dispensing, specific duty medicate dispensing and centralized filtering are 81.93%, 99.67%, and 98.28%, respectively. The passing rates of the microbe indice of the resident contained water are 13.33%, 70.00%, and 43.33%, respectively. The difference has statistical significance. The drinking water disinfection effects of the centralized filtering model and of the specific duty medicate dispensing model are better than that of the separated medicate dispensing model in the flood/waterlog areas.

Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby.

PubMed

Birnbach, David J; Nevo, Igal; Barnes, Susan; Fitzpatrick, Maureen; Rosen, Lisa F; Everett-Thomas, Ruth; Sanko, Jill S; Arheart, Kristopher L

2012-05-01

Reports regarding hand hygiene compliance (HHC) among hospital visitors are limited. Although there is an implicit assumption that the availability of alcohol-based hand sanitizer (AHS) promotes visitor HHC, the degree of AHS use by visitors remains unclear. To assess AHS use, we observed visitor HHC and how it is affected by visual cues in a private university hospital. Using an observational controlled study, we tested 3 interventions: a desk sign mandating all visitors to use AHS, a free-standing AHS dispenser directly in front of a security desk, and a combination of a freestanding AHS dispenser and a sign. HHC was 0.52% at baseline and did not improve significantly when the desk sign was provided as a cue 0.67% (P = .753). However, HHC did improve significantly with use of the freestanding AHS dispenser (9.33%) and the sign and dispenser combination (11.67%) (P < .001 for all comparisons of dispenser alone and sign and dispenser with baseline and sign alone). The degree of improvement with the sign and dispenser combination over the dispenser was not statistically significant. Hospital visitors represent an important factor in infection prevention. A coordinated effort is needed to increase visitor HHC, including an evaluation of the AHS placement, education of visitors on the importance of HHC, and evaluation of corresponding changes in hand hygiene behavior. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

[Briefly analysis on academic origins of traditional Chinese medicine dispensing].

PubMed

Zhao, Xue-Min; Zhang, Xiao-Juan; Zhai, Hua-Qiang; Jin, Shi-Yuan

2014-04-01

Through collecting and collating the development process of traditional Chinese medicine dispensing, the development of modern Chinese medicine dispensing on the basis of experience could be promoted. "Heyaofenji", "Hehe", " Heji" in ancient Chinese medicine, herbal medicine literature and law were collected, and then things were sorted out according to traditional Chinese medicine dispensing theory, skills and legal norms. Firstly, "Tang Ye Jing Fa" is the earliest book which marks the rudiment of traditional Chinese medicine dispensing. Secondly, traditional Chinese medicine dispensing theory formed in "Shen Nong's herbal classic". Thirdly, Zhang Zhongjing's "Treatise on Febrile Diseases" marked the formation of Chinese medicine dispensing skills. Lastly, Provisions in Tang Dynasty law marks the development of traditional Chinese medicine dispensing.

Ultrasound aided smooth dispensing for high viscoelastic epoxy in microelectronic packaging.

PubMed

Chen, Yun; Li, Han-Xiong; Shan, Xiuyang; Gao, Jian; Chen, Xin; Wang, Fuliang

2016-01-01

Epoxy dispensing is one of the most critical processes in microelectronic packaging. However, due its high viscoelasticity, dispensing of epoxy is extremely difficult, and a lower viscoelasticity epoxy is desired to improve the process. In this paper, a novel method is proposed to achieve a lowered viscoelastic epoxy by using ultrasound. The viscoelasticity and molecular structures of the epoxies were compared and analyzed before and after experimentation. Different factors of the ultrasonic process, including power, processing time and ultrasonic energy, were studied in this study. It is found that elasticity is more sensitive to ultrasonic processing while viscosity is little affected. Further, large power and long processing time can minimize the viscoelasticity to ideal values. Due to the reduced loss modulus and storage modulus after ultrasonic processing, smooth dispensing is demonstrated for the processed epoxy. The subsequently color temperature experiments show that ultrasonic processing will not affect LED's lighting. It is clear that the ultrasonic processing will have good potential to aide smooth dispensing for high viscoelastic epoxy in electronic industry. Copyright © 2015 Elsevier B.V. All rights reserved.

Physician Dispensing of Oxycodone and Other Commonly Used Opioids, 2000-2015, United States.

PubMed

Mack, Karin Ann; Jones, Christopher McCall; McClure, Roderick John

2018-05-01

An average of 91 people in the United States die every day from an opioid-related overdose (including prescription opioids and heroin). The direct dispensing of opioids from health care practitioner offices has been linked to opioid-related harms. The objective of this study is to describe the changing nature of the volume of this type of prescribing at the state level. This descriptive study examines the distribution of opioids by practitioners using 1999-2015 Automation of Reports and Consolidated Orders System data. Analyses were restricted to opioids distributed to practitioners. Amount distributed (morphine milligram equivalents [MMEs]) and number of practitioners are presented. Patterns of distribution to practitioners and the number of practitioners varied markedly by state and changed dramatically over time. Comparing 1999 with 2015, the MME distributed to dispensing practitioners decreased in 16 states and increased in 35. Most notable was the change in Florida, which saw a peak of 8.94 MMEs per 100,000 persons in 2010 (the highest distribution in all states in all years) and a low of 0.08 in 2013. This study presents the first state estimates of office-based dispensing of opioids. Increases in direct dispensing in recent years may indicate a need to monitor this practice and consider whether changes are needed. Using controlled substances data to identify high prescribers and dispensers of opioids, as well as examining overall state trends, is a foundational activity to informing the response to potentially high-risk clinical practices.

Prescriptions of opioids to children and adolescents; a study from a national prescription database in Norway.

PubMed

Fredheim, Olav Magnus S; Log, Tomas; Olsen, Wenche; Skurtveit, Svetlana; Sagen, Øystein; Borchgrevink, Petter C

2010-06-01

Analgesics are among the groups of drugs most frequently prescribed to children and adolescents. The prevalence of opioid use in children and adolescents is, however, not known. The primary aim was to determine the 1-year periodic prevalence of opioid dispension in Norwegian children and adolescents below 18 years of age. The secondary aim was to determine to which extent children and adolescents receive opioids for acute or chronic pain. All pharmacies in Norway submit data electronically to the Norwegian Prescription Database on all dispensed prescriptions. All prescriptions to any individual are identified with a pseudonym. All Norwegians who were dispensed opioids from 2004 to 2007 are included in the study. In 2004, 6386 children and adolescents received opioid dispensions, a number which had increased by 35% to 8607 in 2007. These numbers correspond to an increase in 1-year periodic prevalence from 0.59 to 0.79%. Each year during the study period, approximately 95% of the patients received only one or two opioid dispensions. Only 262 Norwegian children and adolescents below 18 years of age received opioid dispensions in three successive years from 2005 to 2007. About 93-95% of children and adolescents receiving opioids each year received the weak opioid codeine. The 1-year periodic prevalence of opioid use in Norwegian children and adolescents is only one-sixteenth of the previously reported prevalence in the Norwegian adult population. Children and adolescents primarily receive opioids for acute pain.

Investigation of Dusts Effect and Negative Ion in DC Plasmas by Electric Probes

NASA Astrophysics Data System (ADS)

Oh, Hye Taek; Kang, Inje; Bae, Min-Keun; Park, Insun; Lee, Seunghwa; Jeong, Seojin; Chung, Kyu-Sun

2017-10-01

Dust is typically negatively charged by electron attachment whose thermal velocities are fast compared to that of the heavier ions. The negatively charged particles can play a role of negative ions which affect the quasi-neutrality of background plasma. To investigate effect of metal dusts and negative ion on plasma and materials, metal dusts are injected into background Ar plasma which is generated by tungsten filament using dust dispenser on Cubical Plasma Device (CPD). The CPD has following conditions: size =24x24x24cm3, plasma source =DC filament plasma (ne 1x10x1010, Te 2eV), background gas =Ar, dusts =tungsten powder (diameter 1.89micron). The dust dispenser is developed to quantitate of metal dust by ultrasonic transducer. Electronegative plasmas are generated by adding O2 + Ar plasma to compare negative ion and dust effect. A few grams of micron-sized dusts are placed in the dust dispenser which is located at the upper side of the Cubical Plasma Device. The falling particles by dust dispenser are mainly charged up by the collection of the background plasma. The change in parameters due to negative ion production are characterized by measuring the floating and plasma potential, electron temperature and negative ion density using electric probes.

What use is generic prescribing?

PubMed Central

Archer, Michael

1985-01-01

The dispensing of generic preparations at four dispensing chemist shops was investigated by means of a questionnaire. Certain generic prescriptions result in the dispensing of proprietary products despite the existence of generic preparations, and the pharmacist may be reimbursed for the cost of the proprietary drug which has been dispensed. Not all generic prescriptions result in the dispensing of cheaper drugs because of the methods of payment to chemists. If doctors write more generic prescriptions there will ultimately be more dispensing of generic products. Even in the case of drugs still under patent, prescribing by generic name should be encouraged. The savings achieved by generic prescribing are to some extent at the cost of the dispensing chemists. The method and scale of payments for dispensing requires urgent review. PMID:4032358

Two for one: a self-management plan coupled with a prescription sheet for children with asthma.

PubMed

Ducharme, Francine M; Noya, Francisco; McGillivray, David; Resendes, Sandy; Ducharme-Bénard, Stéphanie; Zemek, Roger; Bhogal, Sanjit Kaur; Rouleau, Rachel

2008-10-01

Despite strong recommendations in the asthma guidelines, the use of written self-management plans remains low among asthmatic patients. To develop a written self-management plan, based on scientific evidence and expert opinions, in a format intended to facilitate its dispensing by health care professionals, and to test the perception of its relevance and clarity by asthmatic children, adolescents and adults. Inspired by previously tested self-management plans, surveys of asthma educators, expert opinions and the 2004 Canadian Asthma Guidelines, the authors simultaneously developed French and English versions of a written self-management plan that coupled with a prescription. The self-management plan was tested in parents and their asthmatic children (aged one to 17 years), and it was revised until 85% clarity and perceived relevance was achieved. Ninety-seven children and their parents were interviewed. Twenty per cent had a self-management plan. On the final revision, nearly all items were clear and perceived relevant by 85% or more of the interviewees. Two self-management plans were designed for clinics and acute care settings, respectively. The plans are divided into three control zones identified by symptoms with optional peak flow values and symbolized by traffic light colours. They are designed in triplicate format with a prescription slip, a medical chart copy and a patient copy. The written self-management plans, based on available scientific evidence and expert opinions, are clear and perceived to be relevant by children, adolescents and their parents. By incorporating the prescription and chart copies, they were designed to facilitate dispensing by physicians in both clinics and acute care settings.

NSAIDs utilization for musculoskeletal indications in elderly patients with cerebro/cardiovascular disease.

PubMed

Roberto, Giuseppe; Bartolini, Claudia; Rea, Federico; Onder, Graziano; Vitale, Cristiana; Trifirò, Gianluca; Kirchmayer, Ursula; Chinellato, Alessandro; Lucenteforte, Ersilia; Corrao, Giovanni; Mugelli, Alessandro; Lapi, Francesco; Gini, Rosa

2018-05-01

To describe NSAID utilization for musculoskeletal conditions in a large cohort of Italian elderly with cerebro/cardiovascular disease, a population in which NSAIDs should be generally avoided due to the prothrombotic potential. Administrative data from five Italian geographic areas were analyzed. Patients aged ≥ 65 with a cerebro/cardiovascular event recorded between 2008 and 2011 (cohort entry) were selected. Prescription NSAIDs reimbursed for musculoskeletal conditions and dispensed during 1 year follow-up were retrieved to describe (i) prevalence of use, (ii) average amount of defined daily doses of NSAIDs claimed by users per day of follow-up, and (iii) distribution of the received daily dose (RDD) among patients with ≥ 2 dispensings. Among new users, i.e., patients without NSAID dispensings during 2 years before cohort entry, the first dispensed NSAID molecule was observed. Overall, 511,989 patients were selected. Across the five geographic areas, prevalence of use ranged from 48 to 21% and average consumption ranged between 30 and 67 DDD/1000 users/day. Around 10% of patients in the overall cohort had a RDD > 1. Nimesulide (9.6%) and diclofenac (7.5%) had the highest prevalence of use. The most consumed NSAIDs were nimesulide and coxibs with 10.6 and 7.5 DDD/1000 users/day, respectively. Among new users recruited in 2011, 30% had diclofenac or a coxibs as the first prescription. NSAID use was common in the study cohort, particularly in central-southern areas. In contrast with current recommendations, coxibs and diclofenac were among the most prescribed active principles, even in new users. Interventions to promote appropriateness of use are warranted.

Effects of managerial intervention on drug utilization pattern at King Chulalongkorn Memorial Hospital.

PubMed

Limpanasithikul, Wacharee; Wangsaturaka, Danai; Nantawan, Patra; Itthipanichapong, Chandhanee; Thamaree, Sopit; Wittayalertpanya, Supeecha; Ketcharoen, Aurawan; Taworn, Nongnuch; Kemsri, Wandee; Kusolsomboon, Thammarat; Tangphao, Oranee

2002-06-01

The economic crisis in Thailand since 1997 has a major impact on all sections of the country including health care. There were several suggestions for reducing the drug expenditure budget including restriction of hospital formulary, generic prescribing and generic dispensing. At King Chulalongkorn Memorial hospital, the new hospital formulary was established and implemented in March 1998. The generic dispensing policy was also in place at the same time. This study aimed to evaluate the impact of the new implementation by comparing the prescription patterns in out patient departments (OPDs) of the hospital before and after the new hospital formulary implementation. The prescriptions from several OPDs were systematically stratified samplings 5 weeks before and 5 weeks after March 1st, 1998. The information from the prescriptions including drug category, drug name, amount of dispensed drug, drug cost, etc. was collected and analyzed. The total number of prescriptions and the average number of drug items/prescription before and after the implementation were similar (2,049 vs 2,052, and 2.52 +/- 0.048 vs 2.45 +/- 0.03 respectively). The total cost of the prescription, the cost/prescription and the cost/item seemed to be different (1,690,484 baht vs 1,282,343 baht, 844 +/- 54.04 vs 633 +/- 41.11 and 332.58 +/- 29.59 vs 255.29 +/- 19.98 respectively). After the implementation, physicians in the hospital increasingly prescribed drugs by generic name (37.1% vs 44.85%). Locally made drugs were also prescribed by physicians and received by patients more than before (9.56% vs 84.27% and 28.15% vs 60.72%, respectively). Anti-infective agents were studied in depth as they contribute to significant amount of drug expenditure. The total cost of prescribed anti-infective agents and the cost/prescription were increased after the implementation (223,529 vs 274,435 Baht and 585.38 +/- 102.84 vs 772.71 +/- 147.59). The increased cost mainly came from the cost of anti-HIV drugs. Our data indicate that the new hospital formulary may have played a part on the impact of drug expenditure reduction and may have changed the prescribing attitude of physicians in King Chulalongkorn Memorial Hospital.

Trends in opioid use and dosing among socio-economically disadvantaged patients

PubMed Central

Gomes, Tara; Juurlink, David N; Dhalla, Irfan A; Mailis-Gagnon, Angela; Paterson, J Michael; Mamdani, Muhammad M

2011-01-01

Background Opioid therapy for patients with chronic nonmalignant pain remains controversial, primarily because of safety concerns and the potential for abuse. The objective of this study was to examine trends in opioid utilization for nonmalignant pain among recipients of social assistance and to explore the relation between dose of analgesic and mortality. Methods Using a cross-sectional study design, we characterized annual trends in prescriptions for and daily dose of opioid analgesics between 2003 and 2008 for beneficiaries (aged 15 to 64 years) of Ontario’s public drug plan. We defined moderate, high and very high dose thresholds as daily doses of up to 200, 201 to 400, and more than 400 mg oral morphine (or equivalent), respectively. In an exploratory cohort study, we followed, over a 2-year period, patients who received at least one prescription for an opioid in 2004 to investigate the relation between opioid dose and opioid-related mortality. Results Over the study period, opioid prescribing rates rose by 16.2%, and 180 974 individuals received nearly 1.5 million opioid prescriptions in 2008. Also by 2008, the daily dose dispensed exceeded 200 mg morphine equivalent for almost a third (32.6%) of recipients of long-acting oxycodone but only 20.3% of those treated with fentanyl or other long-acting opioids. Among patients for whom high or very high doses of opioids were dispensed in 2004, 19.3% of deaths during the subsequent 2 years were opioid-related, occurring at a median age of 46 years. Two-year opioid-related mortality rates were 1.63 per 1000 population (95% confidence interval [CI] 1.42–1.85) among people with moderate-dose prescriptions, 7.92 per 1000 population (95% CI 5.25–11.49) among those with high-dose prescriptions, and 9.94 per 1000 population (95% CI 2.78–25.12) among those with very-high-dose prescriptions. Interpretation Among socio-economically disadvantaged patients in Ontario, the use and dose of opioids for nonmalignant pain has increased substantially, driven primarily by the use of long-acting oxycodone and, to a lesser extent, fentanyl. The findings of our exploratory study suggested a strong association between opioid-related mortality and the dose of opioid dispensed. PMID:22046214

76 FR 76181 - Certain Electronic Paper Towel Dispensing Devices and Components Thereof; Issuance of General...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

..., 500 E Street SW., Washington, DC 20436, telephone (202) 205-3065. Copies of non-confidential documents..., 500 E Street SW., Washington, DC 20436, telephone (202) 205-2000. General information concerning the...''); Paradigm Marketing Consortium, Inc. of Syosset, New York; United Sourcing Network Corp. of Syosset, New...

Weathering trials of Amulet cue-lure and Amulet methyl eugenol "attract-and-kill" stations with male melon flies and oriental fruit flies (Diptera: Tephritidae) in Hawaii.

PubMed

Vargas, Roger I; Stark, John D; Mackey, Bruce; Bull, Richard

2005-10-01

Amulet C-L (cue-lure) and Amulet ME (methyl eugenol) molded paper fiber "attract-and-kill" dispensers containing fipronil were tested under Hawaiian weather conditions against Bactrocera cucurbitae (Coquillett) (melon fly) and Bactrocera dorsalis (Hendel) (oriental fruit fly), respectively. In paired tests (fresh versus weathered), C-L dispensers were effective for at least 77 d, whereas ME dispensers were effective for at least 21 d. Thus, C-L dispensers exceeded, whereas ME dispensers did not meet the label interval replacement recommendation of 60 d. Addition of 4 ml of ME to 56-d-old ME dispensers restored attraction and kill for an additional 21 d. This result suggested the fipronil added at manufacture was still effective. By enclosing and weathering ME dispensers inside small plastic bucket traps, longevity of ME dispensers was extended up to 56 d. Fipronil ME and C-L dispensers also were compared, inside bucket traps, to other toxicants: spinosad, naled, DDVP, malathion, and permethrin. Against B. dorsalis, fipronil ME dispensers compared favorably only up to 3 wk. Against B. cucurbitae, fipronil C-L dispensers compared favorably for at least 15 wk. Our results suggest that fipronil C-L dispensers can potentially be used in Hawaii; however, fipronil ME dispensers need to be modified or protected from the effects of weathering to extend longevity and meet label specifications. Nonetheless, Amulet C-L and ME dispensers are novel prepackaged formulations containing C-L or ME and fipronil that are more convenient and safer to handle than current liquid insecticide formulations used for areawide suppression of B. dorsalis and B. cucurbitae in Hawaii.

Risk of severe acute liver injury among patients with brain cancer treated with temozolomide: a nested case-control study using the healthcore integrated research database.

PubMed

Desai, Vibha C A; Quinlan, Scott C; Deitz, Anne C; He, Jinghua; Holick, Crystal N; Lanes, Stephan

2017-08-01

Temozolomide (TMZ) is used to treat adult patients with glioblastoma multiforme (GBM). Cases of hepatotoxicity have been reported among patients using TMZ. The objective of the study was to assess the relation, if any, between exposure to TMZ and serious acute liver injury (SALI). We used the HealthCore Integrated Research Database to perform a case-control study nested within a retrospective cohort of adult patients aged 18-100 years with at least two diagnoses of brain cancer anytime between 2006 and 2014. Patients without continuous eligibility or with a SALI diagnosis within 6 months prior to the date of incident brain cancer diagnosis were excluded. Medical records were sought for potential SALI cases and reviewed by two hepatologists. Five controls were selected for each case using incidence density sampling, matched on age and calendar year of index date. The analysis included 61 confirmed SALI cases and 305 selected controls. Exposure to TMZ was classified according to dispensing date and days supply of medication dispensed. We estimated odds ratios using conditional logistic regression models. The odds ratio for any exposure to TMZ was 0.91 (95% CI 0.44-1.91), for recent exposure to TMZ was 0.62 (95% CI 0.21-1.85). There was no increased risk of SALI with increasing duration of exposure to TMZ. When patients with unconfirmed SALI were included in the analysis, results were similar (OR 1.04; 95% CI 0.70-1.54). In conclusion, this study did not find an association between TMZ and SALI risk among patients with brain cancer.

Evaluation of pheromone release from commercial mating disruption dispensers.

PubMed

Tomaszewska, Elizabeth; Hebert, Vincent R; Brunner, Jay F; Jones, Vincent P; Doerr, Mike; Hilton, Richard

2005-04-06

Pome fruit growers and crop consultants have expressed concerns about the seasonal release performance of commercial codling moth mating disruption dispenser products. Because of these concerns, we developed a laboratory flow-through volatile collection system (VCS) for measuring the volatile release of the codling moth sex pheromone, codlemone, from commercially available hand-applied dispensers. Under controlled air-flow and temperature conditions, the released vapor was trapped onto a polyurethane foam adsorbent followed by solvent extraction, solvent reduction, and GC/MS determination. Method recovery and breakthrough validations were performed to demonstrate system reliability before determining codlemone release from commercial dispensers field-aged over 140 days. The volatile collection was carried out in a consistent manner among five dispenser types most commonly used by growers, so that direct comparison of performance could be made. The comparison showed differences in the amount of pheromone released and in the patterns of release throughout the season between dispenser types. The variation in release performance demonstrates the need for routine evaluation of commercially marketed mating disruption dispensers. We believe that the simple and cost-effective volatile collection system can assist pheromone dispenser manufacturers in determining seasonal dispenser performance before new products are introduced into the commercial market and in rapidly verifying dispenser release when field-aged dispenser efficacy is in question.

Structural Barriers to Antiretroviral Therapy Among Sex Workers Living with HIV: Findings of a Longitudinal Study in Vancouver, Canada

PubMed Central

Goldenberg, Shira M.; Montaner, Julio; Duff, Putu; Nguyen, Paul; Dobrer, Sabina; Guillemi, Silvia; Shannon, Kate

2015-01-01

In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010–2012) and linked pharmacy records on ART dispensation. We used logistic regression with generalized estimating equations (GEE) to examine correlates of gaps in ART use (i.e., treatment interruptions or delayed ART initiation), among sex workers living with HIV (n=74). Over a 2.5-year period, 37.8% of participants experienced gaps in ART use (i.e., no ART dispensed in a six-month period). In a multivariable GEE model, younger age, migration/mobility, incarceration, and non-injection drug use independently correlated with gaps in ART use. In spite of successes scaling-up ART in British Columbia, younger, mobile, or incarcerated sex workers face persistent gaps in access and retention irrespective of drug use. Community-based, tailored interventions to scale-up entry and retention in ART for sex workers should be further explored in this setting. PMID:26148850

Structural Barriers to Antiretroviral Therapy Among Sex Workers Living with HIV: Findings of a Longitudinal Study in Vancouver, Canada.

PubMed

Goldenberg, Shira M; Montaner, Julio; Duff, Putu; Nguyen, Paul; Dobrer, Sabina; Guillemi, Silvia; Shannon, Kate

2016-05-01

In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010-2012) and linked pharmacy records on ART dispensation. We used logistic regression with generalized estimating equations (GEE) to examine correlates of gaps in ART use (i.e., treatment interruptions or delayed ART initiation), among HIV seropositive participants (n = 74). Over a 2.5-year period, 37.8 % of participants experienced gaps in ART use (i.e., no ART dispensed in a 6-month period). In a multivariable GEE model, younger age, migration/mobility, incarceration, and non-injection drug use independently correlated with gaps in ART use. In spite of successes scaling-up ART in British Columbia, younger, mobile, or incarcerated sex workers face persistent gaps in access and retention irrespective of drug use. Community-based, tailored interventions to scale-up entry and retention in ART for sex workers should be further explored in this setting.

Improving outpatient primary medication adherence with physician guided, automated dispensing

PubMed Central

Moroshek, Jacob G

2017-01-01

Background Physician dispensing, different from pharmacist dispensing, is a way for practitioners to supply their patients with medications, at the point of care. The InstyMeds dispenser and logistics system can automate much of the dispensing, insurance adjudication, inventory management, and regulatory reporting that is required of physician dispensing. Objective To understand the percentage of patients that exhibit primary adherence to medication in the outpatient setting when choosing InstyMeds. Method The InstyMeds dispensing database was de-identified and analyzed for primary adherence. This is the ratio of patients who dispensed their medication to those who received an eligible prescription. Results The average InstyMeds emergency department installation has a primary adherence rate of 91.7%. The maximum rate for an installed device was 98.5%. Conclusion Although national rates of primary adherence have been found to be in the range of 70%, automated physician dispensing vastly improves the rate of adherence. Improved adherence should lead to better patient outcomes, fewer return visits, and lower healthcare costs. PMID:28115860

Distance traveled and frequency of interstate opioid dispensing in opioid shoppers and nonshoppers.

PubMed

Cepeda, M Soledad; Fife, Daniel; Yuan, Yingli; Mastrogiovanni, Greg

2013-10-01

Little is known about how far opioid shoppers travel or how often they cross state lines to fill their opioid prescriptions. This retrospective cohort study evaluated these measures for opioid shoppers and nonshoppers using a large U.S. prescription database. Patients with ≥3 opioid dispensings were followed for 18 months. A subject was considered a shopper when he or she filled overlapping opioid prescriptions written by >1 prescriber at ≥3 pharmacies. A heavy shopper had ≥5 shopping episodes. Outcomes assessed were distance traveled among pharmacies and number of states visited to fill opioid prescriptions. A total of 10,910,451 subjects were included; .7% developed any shopping behavior and their prescriptions accounted for 8.6% of all opioid dispensings. Shoppers and heavy shoppers were younger than the nonshoppers. Shoppers traveled a median of 83.8 miles, heavy shoppers 199.5 miles, and nonshoppers 0 miles. Almost 20% of shoppers or heavy shoppers, but only 4% of nonshoppers, visited >1 state. Shoppers traveled greater distances and more often crossed state borders to fill opioid prescriptions than nonshoppers, and their dispensings accounted for a disproportionate number of opioid dispensings. Sharing of data among prescription-monitoring programs will likely strengthen those programs and may decrease shopping behavior. This study shows that opioid shoppers travel greater distances and more often cross state borders to fill opioid prescriptions than nonshoppers, and their dispensings accounted for a disproportionate number of opioid dispensings. The findings support the need for data sharing among prescription-monitoring programs to deter opioid shopping behavior. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

Identification of discrete sites in Yip1A necessary for regulation of endoplasmic reticulum structure.

PubMed

Dykstra, Kaitlyn M; Ulengin, Idil; Delrose, Nicholas; Lee, Tina H

2013-01-01

The endoplasmic reticulum (ER) of specialized cells can undergo dramatic changes in structural organization, including formation of concentric whorls. We previously reported that depletion of Yip1A, an integral membrane protein conserved between yeast and mammals, caused ER whorl formation reminiscent of that seen in specialized cells. Yip1A and its yeast homologue Yip1p cycle between the ER and early Golgi, have been implicated in a number of distinct trafficking steps, and interact with a conserved set of binding partners including Yif1p/Yif1A and the Ypt1/Ypt31 Rab GTPases. Here, we carried out a mutational analysis of Yip1A to obtain insight into how it regulates ER whorl formation. Most of the Yip1A cytoplasmic domain was dispensable, whereas the transmembrane (TM) domain, especially residues within predicted TM helices 3 and 4, were sensitive to mutagenesis. Comprehensive analysis revealed two discrete functionally required determinants. One was E95 and flanking residues L92 and L96 within the cytoplasmic domain; the other was K146 and nearby residue V152 within the TM domain. Notably, the identified determinants correspond closely to two sites previously found to be essential for yeast viability (E76 and K130 in Yip1p corresponding to E95 and K146 in Yip1A, respectively). In contrast, a third site (E89) also essential for yeast viability (E70 in Yip1p) was dispensable for regulation of whorl formation. Earlier work showed that E76 (E95) was dispensable for binding Yif1p or Ypt1p/Ypt31p, whereas E70 (E89) was required. Collectively, these findings suggest that the ability of Yip1A to bind its established binding partners may be uncoupled from its ability to control ER whorl formation. In support, Yif1A knockdown did not cause ER whorl formation. Thus Yip1A may use the sites identified herein to interact with a novel binding partner to regulate ER membrane organization.

Characterization of the selection of medicines for the Brazilian primary health care.

PubMed

Karnikowski, Margô Gomes de Oliveira; Galato, Dayani; Meiners, Micheline Marie Milward de Azevedo; Silva, Emília Vitória da; Gerlack, Letícia Farias; Bós, Ângelo José Gonçalves; Leite, Silvana Nair; Álvares, Juliana; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-11-13

To characterize the process of selection of medicines for primary health care in the Brazilian regions. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

Association of air pollution and use of glyceryl trinitrate against angina pectoris: a population-based case-crossover study

PubMed Central

2013-01-01

Background Ambient air pollution has been associated with increased cardiovascular morbidity and mortality. In Reykjavik, Iceland, air pollutant concentrations exceed official health limits several times every year. The aim was to study the association of concentrations of NO2, O3, PM10, and H2S in the Reykjavik capital area with the dispensing of anti-angina pectoris medication, glyceryl trinitrate to the inhabitants. Methods Data on daily dispensing of glyceryl trinitrate, were retrieved from the Icelandic Medicines Registry. Data on hourly concentrations of NO2, O3, PM10, and H2S were obtained from the Environment Agency of Iceland. A case-crossover design was used, based on the dispensing of glyceryl trinitrate to 5,246 individuals (≥18 years) between 2005 and 2009. Results For every 10 μg/m3 increase of NO2 and O3 3-day mean concentrations, the odds ratio (OR) for daily dispensing of glyceryl trinitrates was 1.136 (95% confidence intervals (CI) 1.069-1.207) and 1.094 (95% CI 1.029-1.163) at lag 0, and OR was 1.096 (95% CI 1.029-1.168) and 1.094 (95% CI 1.028-1.166) at lag 1, respectively. Conclusions These findings suggest that NO2 and O3 ambient air concentrations may adversely affect cardiovascular health, as measured by the dispensing of glyceryl trinitrates for angina pectoris. Further, the findings suggest that data on the dispensing of medication may be a valuable health indicator when studying the effect of air pollution on cardiovascular morbidity. PMID:23631813

Influence of community pharmacists׳ attitudes on antibiotic dispensing behavior: a cross-sectional study in Portugal.

PubMed

Roque, Fátima; Soares, Sara; Breitenfeld, Luiza; Figueiras, Adolfo; Herdeiro, Maria Teresa

2015-01-01

The emergence of microbial resistance is widely associated with inappropriate antibiotic use. Self-medication with antibiotics acquired directly from pharmacies without a medical prescription has been reported by several European countries as being an important cause of such inappropriate use. The goal of this study was to identify and evaluate community pharmacists׳ attitudes toward and knowledge of antibiotics and microbial resistance and to assess what influence, if any, these attitudes might have on their propensity to dispense unprescribed antibiotics. We conducted a cross-sectional study covering all community pharmacists registered with the Official College of Pharmacists in Portugal׳s Central Region. A self-administered questionnaire on attitudes toward microbial resistance and antibiotic use was mailed to 1197 pharmacists. Responses ranged from 0 (total disagreement) to 10 (total agreement). Logistic regression was used to model the association between respondents׳ attitudes and their propensity to dispense antibiotics without an earlier medical prescription. The overall response rate was 64.8%. Agreement with the dispensing of unprescribed antibiotics was highest in the case of dental diseases and ailments, followed by urinary tract infections. Although none of the sociodemographic data were associated with a propensity to dispense antibiotics without a medical prescription, the attitudes shown to be significantly associated with this propensity were complacency about patients, responsibility of others, and precaution or fear. Because the attitudes of community pharmacists can influence their readiness to dispense unprescribed antibiotics, educational interventions addressing such attitudes should be implemented to improve antibiotic use. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

A systematic approach for the location of hand sanitizer dispensers in hospitals.

PubMed

Cure, Laila; Van Enk, Richard; Tiong, Ewing

2014-09-01

Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.

The knowledge of emergency contraception and dispensing practices of Patent Medicine Vendors in South West Nigeria.

PubMed

Fayemi, Mojisola M; Oduola, Olufemi L; Ogbuji, Queen C; Osinowo, Kehinde A; Oyewo, Adejoke E; Osiberu, Olabimpe M

2010-09-01

Patent Medicine Vendors (PMVs) can play a critical role in increasing access to emergency contraceptive pills (ECPs) in developing countries, but few studies have examined their knowledge and dispensing practices. Using cluster sampling, the authors selected and interviewed 97 PMVs (60.8 per cent female) in Oyo and Ogun States of Nigeria to assess their knowledge, dispensing practices, and referral for ECPs. About one-third (27.8 per cent) of respondents were not aware of ECPs, and only half knew that ECPs could prevent pregnancy. Forty per cent had ever dispensed ECPs. Reasons proffered by those who do not dispense ECPs included barriers from the State Ministry of Health, police, other regulatory agencies, and religious beliefs. Only 50.5 per cent have referral arrangements for clients. Strategies to increase access to ECPs through PMVs include training on counseling techniques and referral, effective government regulation, and community involvement. Where unsafe abortion is a major cause of maternal mortality, these strategies offer protection for many women in the future.

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM – Services data

PubMed Central

Leite, Silvana Nair; Manzini, Fernanda; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mário; Farias, Mareni Rocha

2017-01-01

ABSTRACT OBJECTIVE To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. METHODS This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. RESULTS The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. CONCLUSION Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities. PMID:29160456

Pharmacy Malpractice: The rate and prevalence of dispensing high-risk prescription-only medications at community pharmacies in Saudi Arabia.

PubMed

Alshammari, Thamir M; Alhindi, Salman A; Alrashdi, Ahmed M; Benmerzouga, Imaan; Aljofan, Mohamad

2017-07-01

To assess the compliance of community pharmacies with the regulations that prohibit the dispensing of prescription-only medications in the absence of a physician prescription in Saudi Arabia. A cross-sectional study was conducted in the period between October 2014 and January 2015. A list of 10 prescription-only medications were selected to be studied. 150 community pharmacies were visited across 6 major regions in Saudi Arabia to assess the prevalence of non-compliance among community pharmacies. Pharmacies were selected in random and researchers (disguised as patients) requested to purchase prescription-only medications in the absence of a prescription. Not all medications were purchased at once. Data were recorded per pharmacy, where pharmacies that approved dispense of the selected drug were scored as non-compliant and the pharmacies that rejected dispense of the selected drug were scored as compliant. Compliance rate was calculated per region per drug. Pharmacies based in governmental hospitals were visited in parallel. A total of 20 were visited. Data and statistical analysis were performed using Statistical Analyses Software (SAS 9.3). A total of 150 pharmacies were visited over a period of 3 months. On average, the percent approved dispense of prescription-only drugs across 6 regions in Saudi Arabia is 63% and the percent rejected dispense is 37% representing a significant non-compliance rate regarding the selected list of medications in this study. The frequency of dispense per medication across 6 major regions in Saudi Arabia is as follows: Isosorbide dinitrate (86%), Enoxaparin (82%), nitroglycerin (74%), Propranolol (73%), Verapamil (70%), Warfarin (65%), Methyldopa (64%), Ciprofloxacin (57%) and Codeine (4%). Non-compliance of community pharmacies with the law of pharmaceutical practice is at an alarming rate in the Kingdom of Saudi Arabia and authoritative figures must intervene to impede and combat such activities .

Design of the POINT study: Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT).

PubMed

Hazen, Ankie C M; Sloeserwij, Vivianne M; Zwart, Dorien L M; de Bont, Antoinette A; Bouvy, Marcel L; de Gier, Johan J; de Wit, Niek J; Leendertse, Anne J

2015-07-02

In the Netherlands, 5.6 % of acute hospital admissions are medication-related. Almost half of these admissions are potentially preventable. Reviewing medication in patients at risk in primary care might prevent these hospital admissions. At present, implementation of medication reviews in primary care is suboptimal: pharmacists lack access to patient information, pharmacists are short of clinical knowledge and skills, and working processes of pharmacists (focus on dispensing) and general practitioners (focus on clinical practice) match poorly. Integration of the pharmacist in the primary health care team might improve pharmaceutical care outcomes. The aim of this study is to evaluate the effect of integration of a non-dispensing pharmacist in general practice on the safety of pharmacotherapy in the Netherlands. The POINT study is a non-randomised controlled intervention study with pre-post comparison in an integrated primary care setting. We compare three different models of pharmaceutical care provision in primary care: 1) a non-dispensing pharmacist as an integral member of a primary care team, 2) a pharmacist in a community pharmacy with a predefined training in performing medication reviews and 3) a pharmacist in a community pharmacy (care as usual). In all models, GPs remain accountable for individual medication prescription. In the first model, ten non-dispensing clinical pharmacists are posted in ten primary care practices (including 5 - 10 000 patients each) for a period of 15 months. These non-dispensing pharmacists perform patient consultations, including medication reviews, and share responsibility for the pharmaceutical care provided in the practice. The two other groups consist of ten primary care practices with collaborating pharmacists. The main outcome measurement is the number of medication-related hospital admissions during follow-up. Secondary outcome measurements are potential medication errors, drug burden index and costs. Parallel to this study, a qualitative study is conducted to evaluate the feasibility of introducing a NDP in general practice. As the POINT study is a large-scale intervention study, it should provide evidence as to whether integration of a non-dispensing clinical pharmacist in primary care will result in safer pharmacotherapy. The qualitative study also generates knowledge on the optimal implementation of this model in primary care. Results are expected in 2016. NTR4389 , The Netherlands National Trial Register, 07-01-2014.

[Access to drugs and the situation of the pharmaceutical market in Ecuador].

PubMed

Ortiz-Prado, Esteban; Galarza, Claudio; León, Fernando Cornejo; Ponce, Jorge

2014-07-01

In the area of public health, it is fundamental to understand the structure and dynamics of the Ecuadorian pharmaceutical market, its segmentation between the public and private sectors, and its relationship with supply and demand, both for generic and brand-name drugs. To achieve this, an observational descriptive study was conducted with information obtained from the available scientific, institutional, technical-administrative, and economic databases. Furthermore, the scientific information concerning the Ecuadorian and regional pharmaceutical market was reviewed through the PubMed and Ovid search engines. In Ecuador, 69.6% of dispensed drugs are brand-name and 30.4% are generics. Of all registered drugs in the country, 1,829 (13.6%) are considered over-the-counter and 11,622 (86.4%) are for sale under medical prescription. In terms of sales, 93.15% correspond to brand-name drugs and only 6.85% to generics. Ninety percent of the pharmacies are located in urban areas and only 10% in rural areas. In the last five years, prices have increased by 12.5% for brand-name drugs and 0.86% for generics. Brand-name drugs are dispensed and consumed 2.3 times more than generics. The majority of pharmacies are located in urban areas, showing that there is a relationship between purchasing power and access to drugs. Although the regulatory authority stipulates that 13% of drugs should be over-the-counter, approximately 60% of the population acquires drugs without a medical prescription.

Implementing a bar-code assisted medication administration system: effects on the dispensing process and user perceptions.

PubMed

Samaranayake, N R; Cheung, S T D; Cheng, K; Lai, K; Chui, W C M; Cheung, B M Y

2014-06-01

We assessed the effects of a bar-code assisted medication administration system used without the support of computerised prescribing (stand-alone BCMA), on the dispensing process and its users. The stand-alone BCMA system was implemented in one ward of a teaching hospital. The number of dispensing steps, dispensing time and potential dispensing errors (PDEs) were directly observed one month before and eight months after the intervention. Attitudes of pharmacy and nursing staff were assessed using a questionnaire (Likert scale) and interviews. Among 1291 and 471 drug items observed before and after the introduction of the technology respectively, the number of dispensing steps increased from five to eight and time (standard deviation) to dispense one drug item by one staff personnel increased from 0.8 (0.09) to 1.5 (0.12) min. Among 2828 and 471 drug items observed before and after the intervention respectively, the number of PDEs increased significantly (P<0.001). 'Procedural errors' and 'missing drug items' were the frequently observed PDEs in the after study. 'Perceived usefulness' and 'job relevance' of the technology decreased significantly (P=0.003 and P=0.004 respectively) among users who participated in the before (N=16) and after (N=16) questionnaires surveys. Among the interviewees, pharmacy staff felt that the system offered less benefit to the dispensing process (9/16). Nursing staff perceived the system as useful in improving the accuracy of drug administration (7/10). Implementing a stand-alone BCMA system may slow down and complicate the dispensing process. Nursing staff believe the stand-alone BCMA system could improve the drug administration process but pharmacy staff believes the technology would be more helpful if supported by computerised prescribing. However, periodical assessments are needed to identify weaknesses in the process after implementation, and all users should be educated on the benefits of using this technology. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

75 FR 76485 - Certain Electronic Paper Towel Dispensing Devices and Components Thereof; Notice of Commission...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

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75 FR 51842 - In the Matter of Certain Electronic Paper Towel Dispensing Devices and Components Thereof; Notice...

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Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies.

PubMed

Cochran, Gary L; Barrett, Ryan S; Horn, Susan D

2016-08-01

The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse-nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated. Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physician's order. Chi-square analysis and Fisher's exact test were used to measure differences between groups of medication-dispensing procedures. Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167). Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Impact of Mobile Dose-Tracking Technology on Medication Distribution at an Academic Medical Center.

PubMed

Kelm, Matthew; Campbell, Udobi

2016-05-01

Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance (p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses (p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses (p = .01). The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed.

Slow Release of Plant Volatiles Using Sol-Gel Dispensers.

PubMed

Bian, L; Sun, X L; Cai, X M; Chen, Z M

2014-12-01

The black citrus aphid, also known as the tea aphid, (Toxoptera aurantii Boyer) attacks economically important crops, including tea (Camellia sinensis (L.) O. Kuntze). In the current study, silica sol-gel formulations were screened to find one that could carry and release C. sinensis plant volatiles to lure black citrus aphids in a greenhouse. The common plant volatile trans-2-hexen-1-al was used as a model molecule to screen for suitable sol-gel formulations. A zNose (Electronic Sensor Technology, Newbury Park, CA) transportable gas chromatograph was used to continuously monitor the volatile emissions. A sol-gel formulation containing tetramethyl orthosilicate and methyltrimethoxysilane in an 8:2 (vol:vol) ratio was selected to develop a slow-release dispenser. The half-life of trans-2-hexen-1-al in the sol-gel dispenser increased slightly with the volume of this compound in the dispenser. Ten different volatiles were tested in the sol-gel dispenser. Alcohols of 6-10 carbons had the longest half-lives (3.01-3.77 d), while esters of 6-12 carbons had the shortest (1.53-2.28 d). Release of these volatiles from the dispensers could not be detected by the zNose after 16 d (cis-3-hexenyl acetate) to 26 d (3,7-dimethylocta-1,6-dien-3-ol). In greenhouse experiments, trans-2-hexen-1-al and cis-3-hexen-1-ol released from the sol-gel dispensers attracted aphids for ≍17 d, and release of these volatiles could not be detected by the zNose after ≍24 d. The sol-gel dispensers performed adequately for the slow release of plant volatiles to trap aphids in the greenhouse. © 2014 Entomological Society of America.

Adherence to national recommendations for safe methotrexate dispensing in community pharmacies.

PubMed

Koster, Ellen S; Walgers, Joelle C D; van Grinsven, Mariska C J; Winters, Nina A; Bouvy, Marcel L

2014-02-01

The number of patients using methotrexate (MTX) has increased during the last decade. Because of the narrow therapeutic range and potential risks of incorrect use, vigilance is required when dispensing MTX. In 2009, the Royal Dutch Pharmacists Society, in accordance with the Dutch Health Care Inspectorate, published safe MTX dispensing recommendations for community pharmacies. To examine adherence to recommendations aimed at safe 
MTX dispensing. This study was conducted within a convenience sample of 78 community pharmacies belonging to the Utrecht Pharmacy Practice Network for Education and Research (UPPER). Data were collected in May 2011. 95 pharmacists and 337 pharmacy technicians were interviewed to assess self-reported adherence with dispensing recommendations. In addition, medication records for patients using MTX were extracted in 52 pharmacies in order to objectively assess adoption of recommendations. More than 75% of the pharmacists and pharmacy technicians reported to be adherent to 6 of the 11 recommendations. There are variations in reported adherence between team members working in 1 pharmacy; higher adherence rates ( greater than 75%) for the pharmacy team as a whole were only shown for 2 recommendations (recording of day of intake on the label and moment of authorization by the pharmacist). The medication records showed that adherence with working procedures significantly increased: The number of dispensed records with notification of the day of intake on the medication label increased from 9.9% of the records per pharmacy in 2008 to 77.1% in 2010 (P  less than  0.001). Dutch community pharmacies seem to be adherent to most safe dispensing recommendations. However, inconsistencies exist between team members that emphasize the importance of addressing this issue and discussing recommendations within the team, as there is still room for improvement to ensure safe dispensing.

The Australian rise of esomeprazole-was expenditure on samples a contributor?

PubMed

Kyle, Gregory J; Nissen, Lisa M; Tett, Susan E

2009-01-01

Administrative data from the Australian Pharmaceutical Benefits Scheme (PBS) showed rapid growth of esomeprazole dispensing when it was launched. Australia has universal prescription medicine coverage (the PBS), which included esomeprazole from August 2002. Free samples of new medicines are commonly provided to doctors. To determine if a relationship exists between marketing expenditure on samples and the dispensing rate for esomeprazole in Australia between June 2002 and September 2006. Quarterly sample expenditures at product/brand level for proton pump inhibitors (PPIs) for Australian general practitioners were obtained for July 2002 to September 2006. Corresponding PBS dispensing data were obtained for all PPIs and converted to defined daily dose (DDD)/1000 population/day. Spending on samples was calculated as dollars per dispensed prescription and plotted against time on the Australian market. Total PPI usage increased from 34.2 to 50.8 DDD/1000 population/day over the study period. Expenditure on samples per dispensed prescription was higher when a PPI was new on the market and diminished over 5-6 years to a relatively constant level. The rapid decline in this ratio was demonstrated by a case study following esomeprazole from launch in Australia for almost 5 years clearly demonstrating the initial investment to drive sales. A relationship appears to exist between expenditure on esomeprazole samples and its usage in Australia. A high initial investment was followed by a rapid reduction in cost per prescription dispensed, predominantly due to growth in market share. This trend was consistent with other PPIs.

Isolation of Raoultella planticola from refillable antimicrobial liquid soap dispensers in a dental setting

PubMed Central

Tomlin, Nancy; Ruby, John D.

2014-01-01

Background Liquid antimicrobial soaps are commonly used in the dental healthcare setting for hand washing to minimize the potential spread of infectious agents to healthcare workers (HCW) and patients. The purpose of the current study was to evaluate possible bacterial contamination of antimicrobial liquid soap dispensers located in two institutional comprehensive dental care clinics. Methods Fourteen soap dispensers and original stock containers were sampled. A 1 ml aliquot was diluted in 10 ml of phosphate buffer (Tween 80). Serial dilutions were plated in duplicate on neutralizing agar and incubated for 7 days. Molecular identification was performed using 500 bp comparisons of 16S rDNA sequencing. Taq PCR was performed with sequence specific primers for Raoultella species. Results Bacterial growth was observed at 18 hours for 57% (8/14) of soap dispenser samples. Bacterial densities ranged from 4 ×102–6 ×109 CFU/mL. Original commercial containers exhibited no growth. Isolates were identified as Raoultella (Klebsiella) planticola. Conclusions This is the first study indicating recovery of R. planticola from antimicrobial liquid soap dispensers. R. planticola is a recognized environmental opportunistic pathogen that potentially poses a health concern. Practical Implications These findings indicate compliance problems with infection prevention recommendations and support the CDC’s recommendation that dispensers should not be “topped off”. High bacterial loads of R. planticola are inconsistent with infection control practices and are a concern since transmission and possible infection to the HCW or the patient may occur. PMID:25819655

Hydrogen fuel dispensing station for transportation vehicles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singh, S.P.N.; Richmond, A.A.

1995-07-01

A technical and economic assessment is being conducted of a hydrogen fuel dispensing station to develop an understanding of the infrastructure requirements for supplying hydrogen fuel for mobile applications. The study includes a process design of a conceptual small-scale, stand-alone, grassroots fuel dispensing facility (similar to the present-day gasoline stations) producing hydrogen by steam reforming of natural gas. Other hydrogen production processes (such as partial oxidation of hydrocarbons and water electrolysis) were reviewed to determine their suitability for manufacturing the hydrogen. The study includes an assessment of the environmental and other regulatory permitting requirements likely to be imposed on amore » hydrogen fuel dispensing station for transportation vehicles. The assessment concludes that a dispensing station designed to produce 0.75 million standard cubic feet of fuel grade (99.99%+ purity) hydrogen will meet the fuel needs of 300 light-duty vehicles per day. Preliminary economics place the total capital investment (in 1994 US dollars) for the dispensing station at $4.5 million and the annual operating costs at around $1 million. A discounted cash-flow analysis indicates that the fuel hydrogen product price (excluding taxes) to range between $1.37 to $2.31 per pound of hydrogen, depending upon the natural gas price, the plant financing scenario, and the rate of return on equity capital. A report on the assessment is due in June 1995. This paper presents a summary of the current status of the assessment.« less

Surface, Water and Air Biocharacterization (SWAB)

NASA Image and Video Library

2009-08-18

ISS020-E-031558 (18 Aug. 2009) --- NASA astronaut Michael Barratt, Expedition 20 flight engineer, conducts a Surface, Water and Air Biocharacterization (SWAB) water sampling from the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station. SWAB uses advanced molecular techniques to comprehensively evaluate microbes onboard the space station, including pathogens (organisms that may cause disease). This study will allow an assessment of the risk of microbes to the crew and the spacecraft.

Williams conducts SWAB Sampling during Expedition 22

NASA Image and Video Library

2010-03-15

ISS022-E-094369 (15 March 2010) --- NASA astronaut Jeffrey Williams, Expedition 22 commander, conducts a Surface, Water and Air Biocharacterization (SWAB) water sampling from the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station. SWAB uses advanced molecular techniques to comprehensively evaluate microbes onboard the space station, including pathogens (organisms that may cause disease). This study will allow an assessment of the risk of microbes to the crew and the spacecraft.

Williams conducts SWAB Sampling during Expedition 22

NASA Image and Video Library

2010-03-15

ISS022-E-094374 (15 March 2010) --- NASA astronaut Jeffrey Williams, Expedition 22 commander, conducts a Surface, Water and Air Biocharacterization (SWAB) water sampling from the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station. SWAB uses advanced molecular techniques to comprehensively evaluate microbes onboard the space station, including pathogens (organisms that may cause disease). This study will allow an assessment of the risk of microbes to the crew and the spacecraft.

A Simulated Learning Environment for Teaching Medicine Dispensing Skills

PubMed Central

Styles, Kim; Sewell, Keith; Trinder, Peta; Marriott, Jennifer; Maher, Sheryl; Naidu, Som

2016-01-01

Objective. To develop an authentic simulation of the professional practice dispensary context for students to develop their dispensing skills in a risk-free environment. Design. A development team used an Agile software development method to create MyDispense, a web-based simulation. Modeled on virtual learning environments elements, the software employed widely available standards-based technologies to create a virtual community pharmacy environment. Assessment. First-year pharmacy students who used the software in their tutorials, were, at the end of the second semester, surveyed on their prior dispensing experience and their perceptions of MyDispense as a tool to learn dispensing skills. Conclusion. The dispensary simulation is an effective tool for helping students develop dispensing competency and knowledge in a safe environment. PMID:26941437

Plasmids with a Chromosome-Like Role in Rhizobia ▿ †

PubMed Central

Landeta, Cristina; Dávalos, Araceli; Cevallos, Miguel Ángel; Geiger, Otto; Brom, Susana; Romero, David

2011-01-01

Replicon architecture in bacteria is commonly comprised of one indispensable chromosome and several dispensable plasmids. This view has been enriched by the discovery of additional chromosomes, identified mainly by localization of rRNA and/or tRNA genes, and also by experimental demonstration of their requirement for cell growth. The genome of Rhizobium etli CFN42 is constituted by one chromosome and six large plasmids, ranging in size from 184 to 642 kb. Five of the six plasmids are dispensable for cell viability, but plasmid p42e is unusually stable. One possibility to explain this stability would be that genes on p42e carry out essential functions, thus making it a candidate for a secondary chromosome. To ascertain this, we made an in-depth functional analysis of p42e, employing bioinformatic tools, insertional mutagenesis, and programmed deletions. Nearly 11% of the genes in p42e participate in primary metabolism, involving biosynthetic functions (cobalamin, cardiolipin, cytochrome o, NAD, and thiamine), degradation (asparagine and melibiose), and septum formation (minCDE). Synteny analysis and incompatibility studies revealed highly stable replicons equivalent to p42e in content and gene order in other Rhizobium species. A systematic deletion analysis of p42e allowed the identification of two genes (RHE_PE00001 and RHE_PE00024), encoding, respectively, a hypothetical protein with a probable winged helix-turn-helix motif and a probable two-component sensor histidine kinase/response regulator hybrid protein, which are essential for growth in rich medium. These data support the proposal that p42e and its homologous replicons (pA, pRL11, pRLG202, and pR132502) merit the status of secondary chromosomes. PMID:21217003

The effect of removing funding restrictions for atorvastatin differed across sociodemographic groups among New Zealanders hospitalised with cardiovascular disease: a national data linkage study.

PubMed

Mehta, Suneela; Wells, Sue; Jackson, Rod; Harrison, Jeff; Kerr, Andrew

2016-10-14

Publicly-funded atorvastatin required prior approval until September 2010 whereas simvastatin did not. Our aim was to examine if overall statin dispensing and atorvastatin dispensing among patients hospitalised for cardiovascular disease (CVD) differed systematically across sociodemographic groups during and after special authority criteria. National medication dispensing data were anonymously linked to patients hospitalised across New Zealand with CVD and discharged between 1/07/2009-31/12/2009 when special authority criteria applied and 1/09/2010-28/02/2011 after restrictions ceased. Statin dispensing at least once within six months post-discharge was analysed by sociodemographic characteristics. Overall statin use was the same (80%) among patients discharged during (n=14,094) and after (n=13,274) restrictions. With restrictions, atorvastatin dispensing was 32-33% less frequent among statin-users <45 years and >75 years than 65-74 year olds and 28-55% less among Māori, Pacific and Indian peoples than all others. Minimal relative differences occurred by sex or deprivation status. After restrictions were lifted, the proportion of statin-users dispensed atorvastatin increased around two-fold or more across all sociodemographic strata with three-four fold increases for patients >55 years and for Māori, Pacific and Indian peoples. After funding restrictions ceased, disparities in atorvastatin dispensing appeared to reduce across age and ethnic groups among patients with CVD-related hospitalisations, but overall statin use was unchanged.

76 FR 27352 - Agency Information Collection Activities: Proposed Collection; Comments Requested: Dispensing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-11

... Collection Activities: Proposed Collection; Comments Requested: Dispensing Records of Individual.../Collection: Dispensing records of individual practitioners. (3) Agency form number, if any, and the... requires that individual practitioners keep records of the dispensing and administration of controlled...

Preliminary Assessment of Spatial Competition in the Market for E85

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bentley Clinton

The Preliminary Assessment of Spatial Competition in the Market for E85 presentation and supplementary report from the U.S. Department of Energy’s National Renewable Energy Laboratory examine how the spacing of E85 fueling stations impacts E85 retail pricing. The analysis finds an inverse correlation between station density and E85 prices, with local competition putting downward pressure on E85 prices. A gas station with E85 whose nearest competitor is within a 0.5 mile radius is associated with a lower E85 price per gallon than an otherwise identical station with E85 whose nearest competitor is farther away. The analysis also finds a highermore » level of correlation between E85 and both E10 and wholesale gasoline prices than with ethanol costs. This indicates that E85 may, in fact, be priced with respect to its substitute fuel, and not based on the cost of its inputs. These findings help identify key trends and barriers in E85 markets and highlight data gaps that, if addressed, could help enable competitive E85 markets. The analysis was released in February 2017 and uses national and Minnesota-specific price data.« less

Preliminary Assessment of Spatial Competition in the Market for E85: Presentation Supplement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clinton, Bentley; Johnson, Caley; Moriarty, Kristi

The Preliminary Assessment of Spatial Competition in the Market for E85 presentation and supplementary report from the U.S. Department of Energy’s National Renewable Energy Laboratory examine how the spacing of E85 fueling stations impacts E85 retail pricing. The analysis finds an inverse correlation between station density and E85 prices, with local competition putting downward pressure on E85 prices. A gas station with E85 whose nearest competitor is within a 0.5 mile radius is associated with a lower E85 price per gallon than an otherwise identical station with E85 whose nearest competitor is farther away. The analysis also finds a highermore » level of correlation between E85 and both E10 and wholesale gasoline prices than with ethanol costs. This indicates that E85 may, in fact, be priced with respect to its substitute fuel, and not based on the cost of its inputs. These findings help identify key trends and barriers in E85 markets and highlight data gaps that, if addressed, could help enable competitive E85 markets. The analysis was released in February 2017 and uses national and Minnesota-specific price data.« less

Trends and changes in prescription opioid analgesic dispensing in Canada 2005–2012: an update with a focus on recent interventions

PubMed Central

2014-01-01

Background Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. Canada features the world’s second-highest POA consumption rates. Following increases in POA-related harm, several POA control interventions have been implemented since 2010. Methods We examined trends and patterns in POA dispensing in Canada by province for 2005–2012, including a focus on the potential effects of interventions. Data on annual dispensing of individual POA formulations – categorized into ‘weak opioids’ and ‘strong opioids’ – from a representative sub-sample of 5,700 retail pharmacies across Canada (from IMS Brogan’s Compuscript) were converted into Defined Daily Doses (DDD), and examined intra- and inter-provincially as well as for Canada (total). Results Total POA dispensing – driven by strong opioids – increased across Canada until 2011; four provinces indicated decreases in strong opioid dispensing; seven provinces indicated decreases specifically in oxycodone dispensing, 2011–2012. The dispensing ratio weak/strong opioids decreased substantively. Major inter-provincial differences in POA dispensing levels and qualitative patterns of POA formulations dispensed persisted. Previous increasing trends in POA dispensing were reversed in select provinces 2011–2012, coinciding with POA-related interventions. Conclusions Further examinations regarding the sustained nature, drivers and consequences of the recent trend changes in POA dispensing – including possible ‘substitution effects’ for oxycodone reductions – are needed. PMID:24572005

Older Adults’ Satisfaction with a Medication Dispensing Device in Home Care

PubMed Central

Demiris, George; Marek, Karen D.

2014-01-01

Introduction Older adults with multiple chronic conditions face the complex task of medication management involving multiple medications of varying doses at different times. Advances in telehealth technologies have resulted in home-based devices for medication management and health monitoring of older adults. We examined older adults’ perceptions of a telehealth medication dispensing device as part of a clinical trial involving home health care clients, nurse coordination and use of the medication dispensing device. Methods Ninety-six frail older adult participants who used the medication dispensing device for 12 months completed a satisfaction survey related to perceived usefulness and reliability. Results were analyzed and grouped by themes in the following areas: Ease of Use, Reliability, Medication Management Assistance, Routine Task Performance and Acceptability. Results Nearly all participants perceived the medication dispensing device as very easy to use, very reliable and helpful in management of their medications. Eighty-four percent of participants expressed a desire to use the machine in the future. Conclusion The technology-enhanced medication management device in this study is an acceptable tool for older adults to manage medication in collaboration with home care nurses. Improved usability and cost models for medication dispensers are areas for future research. Trial Registration clinicaltrials.gov identifier: NCT01321853 PMID:23323721

Analysis of algal chlorophylls and carotenoids

NASA Astrophysics Data System (ADS)

Bidigare, Robert R.

Water samples should be collected with Go-Flo bottles to avoid the contamination problems associated with the latex rubber closure mechanism of Niskin bottles [Williams and Robertson, 1989]. Price et al. [1986] have documented that latex rubber is extremely toxic to marine phytoplankton. It is recommended that only silicone tubing be used to dispense seawater into sample bottles. Seawater is dispensed into opaque Nalgene sample bottles to avoid light shock to deep-living phytoplankton assemblages. If pigment samples are collected to examine the dynamics of the diatoxanthin-diadinoxanthin (DT-DN) xanthophyll cycle, then casts should be performed quickly, i.e. less than 6 minutes, to minimize DT-DN interconversion prior to filtration [Welschmeyer and Hoepffner, in press; Welschmeyer, personal communication, 1990].

Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia.

PubMed

Kalungia, Aubrey Chichonyi; Burger, Johanita; Godman, Brian; Costa, Juliana de Oliveira; Simuwelu, Chimwemwe

2016-12-01

In Zambia, antibiotics are categorized as prescription-only medicines. Antibiotics dispensed without a prescription pose a public health threat, which is a concern. Consequently, the aim is to ascertain the extent of non-prescription sales and dispensing of antibiotics in community pharmacies in Zambia. The practice of non-prescription sale and dispensing were assessed in 73 randomly selected community retail pharmacies, using a structured interviewer-administered questionnaire with simulated case scenarios. Majority (97%) stated that clients frequently requested non-prescribed antibiotics. Interviewees usually asked clients' indications (94%), counselled on dosing (96%) and suggested changes to antibiotic choices (97%). All (100%) dispensed non-prescribed antibiotics. Commonly dispensed antibiotics included amoxicillin (52%), cotrimoxazole (25%) and metronidazole (23%). Non-prescription sale and dispensing of antibiotics was significantly associated with interviewees' professional qualification in four out of five simulations. Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement to reduce this.

Kuipers lubricates and cleans the beverage adapter on the PWD

NASA Image and Video Library

2012-01-23

ISS030-E-156300 (23 Jan. 2012) --- European Space Agency astronaut Andre Kuipers, Expedition 30 flight engineer, lubricates and cleans the beverage adapter on the Potable Water Dispenser (PWD) in the Harmony node of the International Space Station.

Swans replacing filter in U.S. Laboratory

NASA Image and Video Library

2014-07-15

ISS040-E-064624 (15 July 2014) --- NASA astronaut Steve Swanson, Expedition 40 commander, replaces filters in the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station. NASA astronaut Reid Wiseman, flight engineer, works in the background.

Pettit performs an in-flight maintenenace on the PWD in the U.S. Laboratory

NASA Image and Video Library

2012-02-12

ISS030-E-074046 (12 Feb. 2012) --- NASA astronaut Don Pettit, Expedition 30 flight engineer, performs in-flight maintenance on the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station.

Pettit performs an in-flight maintenenace on the PWD in the U.S. Laboratory

NASA Image and Video Library

2012-02-12

ISS030-E-074045 (12 Feb. 2012) --- NASA astronaut Don Pettit, Expedition 30 flight engineer, performs in-flight maintenance on the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station.

Pettit performs an in-flight maintenenace on the PWD in the U.S. Laboratory

NASA Image and Video Library

2012-02-12

ISS030-E-074042 (12 Feb. 2012) --- NASA astronaut Don Pettit, Expedition 30 flight engineer, performs in-flight maintenance on the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station.

Pettit performs an in-flight maintenenace on the PWD in the U.S. Laboratory

NASA Image and Video Library

2012-02-12

ISS030-E-074044 (12 Feb. 2012) --- NASA astronaut Don Pettit, Expedition 30 flight engineer, performs in-flight maintenance on the Potable Water Dispenser (PWD) in the Destiny laboratory of the International Space Station.

IoT for Real-Time Measurement of High-Throughput Liquid Dispensing in Laboratory Environments.

PubMed

Shumate, Justin; Baillargeon, Pierre; Spicer, Timothy P; Scampavia, Louis

2018-04-01

Critical to maintaining quality control in high-throughput screening is the need for constant monitoring of liquid-dispensing fidelity. Traditional methods involve operator intervention with gravimetric analysis to monitor the gross accuracy of full plate dispenses, visual verification of contents, or dedicated weigh stations on screening platforms that introduce potential bottlenecks and increase the plate-processing cycle time. We present a unique solution using open-source hardware, software, and 3D printing to automate dispenser accuracy determination by providing real-time dispense weight measurements via a network-connected precision balance. This system uses an Arduino microcontroller to connect a precision balance to a local network. By integrating the precision balance as an Internet of Things (IoT) device, it gains the ability to provide real-time gravimetric summaries of dispensing, generate timely alerts when problems are detected, and capture historical dispensing data for future analysis. All collected data can then be accessed via a web interface for reviewing alerts and dispensing information in real time or remotely for timely intervention of dispense errors. The development of this system also leveraged 3D printing to rapidly prototype sensor brackets, mounting solutions, and component enclosures.

What drives inappropriate antibiotic dispensing? A mixed-methods study of pharmacy employee perspectives in Haryana, India.

PubMed

Barker, Anna K; Brown, Kelli; Ahsan, Muneeb; Sengupta, Sharmila; Safdar, Nasia

2017-03-02

There are only 0.70 licensed physicians per 1000 people in India. Thus, pharmacies are a primary source of healthcare and patients often seek their services directly, especially in village settings. However, there is wide variability in a pharmacy employee's training, which contributes to inappropriate antibiotic dispensing and misuse. These practices increase the risk of antibiotic resistance and poor patient outcomes. This study seeks to better understand the factors that drive inappropriate antibiotic dispensing among pharmacy employees in India's village communities. We conducted a mixed-methods study of the antibiotic dispensing practices, including semistructured interviews and a pilot cross-sectional Knowledge, Attitudes and Practice survey. All data were transcribed, translated from Hindi into English, and coded for themes. Community pharmacies in villages in Haryana, India. We recruited 24 community pharmacy employees (all male) by convenience sampling. Participants have a range of characteristics regarding village location, monthly income, baseline antibiotic knowledge, formal education and licensure. 75% of pharmacy employees in our study were unlicensed practitioners, and the majority had very limited understanding of antibiotic resistance. Furthermore, only half could correctly define the term antibiotics. All reported that at times they dispensed antibiotics without a prescription. This practice was more common when treating patients who had limited access to a licensed physician because of economic or logistic reasons. Many pharmacy workers also felt pressure to provide shortened medication courses to poorer clientele, and often dispensed only 1 or 2 days' worth of antibiotics. Such patients rarely returned to the pharmacy for the complete course. This study highlights the need for short-term, intensive training programmes on antibiotic prescribing and resistance that can be disseminated to village pharmacies. Programme development should take into account the realities of working with poor clientele, especially in areas of limited healthcare access. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

21 CFR 209.11 - Dispensing and distributing the side effects statement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SERVICES (CONTINUED) DRUGS: GENERAL REQUIREMENT FOR AUTHORIZED DISPENSERS AND PHARMACIES TO DISTRIBUTE A...) Each authorized dispenser or pharmacy must distribute the side effects statement with each prescription... distributed with new and refill prescriptions. (b) An authorized dispenser or pharmacy must choose one or more...

21 CFR 209.11 - Dispensing and distributing the side effects statement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SERVICES (CONTINUED) DRUGS: GENERAL REQUIREMENT FOR AUTHORIZED DISPENSERS AND PHARMACIES TO DISTRIBUTE A...) Each authorized dispenser or pharmacy must distribute the side effects statement with each prescription... distributed with new and refill prescriptions. (b) An authorized dispenser or pharmacy must choose one or more...

21 CFR 209.11 - Dispensing and distributing the side effects statement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SERVICES (CONTINUED) DRUGS: GENERAL REQUIREMENT FOR AUTHORIZED DISPENSERS AND PHARMACIES TO DISTRIBUTE A...) Each authorized dispenser or pharmacy must distribute the side effects statement with each prescription... distributed with new and refill prescriptions. (b) An authorized dispenser or pharmacy must choose one or more...

21 CFR 209.11 - Dispensing and distributing the side effects statement.

Code of Federal Regulations, 2014 CFR

2014-04-01

... SERVICES (CONTINUED) DRUGS: GENERAL REQUIREMENT FOR AUTHORIZED DISPENSERS AND PHARMACIES TO DISTRIBUTE A...) Each authorized dispenser or pharmacy must distribute the side effects statement with each prescription... distributed with new and refill prescriptions. (b) An authorized dispenser or pharmacy must choose one or more...

21 CFR 209.11 - Dispensing and distributing the side effects statement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SERVICES (CONTINUED) DRUGS: GENERAL REQUIREMENT FOR AUTHORIZED DISPENSERS AND PHARMACIES TO DISTRIBUTE A...) Each authorized dispenser or pharmacy must distribute the side effects statement with each prescription... distributed with new and refill prescriptions. (b) An authorized dispenser or pharmacy must choose one or more...

The impact of the Canterbury earthquakes on prescribing for mental health.

PubMed

Beaglehole, Ben; Bell, Caroline; Frampton, Christopher; Hamilton, Greg; McKean, Andrew

2015-08-01

The aim of this study is to evaluate the impact of the Canterbury earthquakes on the mental health of the local population by examining prescribing patterns of psychotropic medication. Dispensing data from community pharmacies for antidepressants, antipsychotics, anxiolytics and sedatives/hypnotics are routinely recorded in a national database. The close relationship between prescribing and dispensing provides the opportunity to assess prescribing trends for Canterbury compared to national data and therefore examines the longitudinal impact of the earthquakes on prescribing patterns. Short-term increases in the use of anxiolytics and sedatives/hypnotics were observed after the most devastating February 2011 earthquake, but this effect was not sustained. There were no observable effects of the earthquakes on antidepressant or antipsychotic dispensing. Short-term increases in dispensing were only observed for the classes of anxiolytics and sedatives/hypnotics. No sustained changes in dispensing occurred. These findings suggest that long-term detrimental effects on the mental health of the Canterbury population were either not present or have not resulted in increased prescribing of psychotropic medication. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Optimizing the Point-Source Emission Rates and Geometries of Pheromone Mating Disruption Mega-Dispensers.

PubMed

Baker, T C; Myrick, A J; Park, K C

2016-09-01

High-emission-rate "mega-dispensers" have come into increasing use for sex pheromone mating disruption of moth pests over the past two decades. These commercially available dispensers successfully suppress mating and reduce crop damage when they are deployed at very low to moderate densities, ranging from 1 to 5/ha to 100-1000/ha, depending on the dispenser types and their corresponding pheromone emission rates. Whereas traditionally the emission rates for successful commercial mating disruption formulations have been measured in terms of amounts (usually milligram) emitted by the disruptant application per acre or hectare per day, we suggest that emission rates should be measured on a per-dispenser per-minute basis. In addition we suggest, because of our knowledge concerning upwind flight of male moths being dependent on contact with pheromone plume strands, that more attention needs to be paid to optimizing the flux within plume strands that shear off of any mating disruption dispenser's surface. By measuring the emission rates on a per-minute basis and measuring the plume strand concentrations emanating from the dispensers, it may help improve the ability of the dispensers to initiate upwind flight from males and initiate their habituation to the pheromone farther downwind than can otherwise be achieved. In addition, by optimizing plume strand flux by paying attention to the geometries and compactness of mating disruption mega-dispensers may help reduce the cost of mega-dispenser disruption formulations by improving their behavioral efficacy while maintaining field longevity and using lower loading rates per dispenser.

30 CFR 71.603 - Drinking water; dispensing requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Drinking water; dispensing requirements. 71.603... COAL MINES Drinking Water § 71.603 Drinking water; dispensing requirements. (a) Water shall be dispensed through a drinking fountain or from a water storage container with an adequate supply of single...

30 CFR 71.603 - Drinking water; dispensing requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Drinking water; dispensing requirements. 71.603... COAL MINES Drinking Water § 71.603 Drinking water; dispensing requirements. (a) Water shall be dispensed through a drinking fountain or from a water storage container with an adequate supply of single...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 24 2014-07-01 2014-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 25 2013-07-01 2013-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

21 CFR 888.4200 - Cement dispenser.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Cement dispenser. 888.4200 Section 888.4200 Food... DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4200 Cement dispenser. (a) Identification. A cement dispenser is a nonpowered syringe-like device intended for use in placing bone cement (§ 888.3027) into...

21 CFR 888.4200 - Cement dispenser.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Cement dispenser. 888.4200 Section 888.4200 Food... DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4200 Cement dispenser. (a) Identification. A cement dispenser is a nonpowered syringe-like device intended for use in placing bone cement (§ 888.3027) into...

21 CFR 888.4200 - Cement dispenser.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cement dispenser. 888.4200 Section 888.4200 Food... DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4200 Cement dispenser. (a) Identification. A cement dispenser is a nonpowered syringe-like device intended for use in placing bone cement (§ 888.3027) into...

21 CFR 888.4200 - Cement dispenser.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Cement dispenser. 888.4200 Section 888.4200 Food... DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4200 Cement dispenser. (a) Identification. A cement dispenser is a nonpowered syringe-like device intended for use in placing bone cement (§ 888.3027) into...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

14 CFR 23.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Equipment standards for oxygen dispensing... Equipment Miscellaneous Equipment § 23.1447 Equipment standards for oxygen dispensing units. If oxygen... occupant for whom supplemental oxygen is to be supplied. Each dispensing unit must: (1) Provide for...

14 CFR 23.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Equipment standards for oxygen dispensing... Equipment Miscellaneous Equipment § 23.1447 Equipment standards for oxygen dispensing units. If oxygen... occupant for whom supplemental oxygen is to be supplied. Each dispensing unit must: (1) Provide for...

14 CFR 23.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Equipment standards for oxygen dispensing... Equipment Miscellaneous Equipment § 23.1447 Equipment standards for oxygen dispensing units. Link to an amendment published at 76 FR 75762, December 2, 2011. If oxygen dispensing units are installed, the...

14 CFR 23.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Equipment standards for oxygen dispensing... Equipment Miscellaneous Equipment § 23.1447 Equipment standards for oxygen dispensing units. If oxygen... occupant for whom supplemental oxygen is to be supplied. Each dispensing unit must: (1) Provide for...

14 CFR 23.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Equipment standards for oxygen dispensing... Equipment Miscellaneous Equipment § 23.1447 Equipment standards for oxygen dispensing units. If oxygen... occupant for whom supplemental oxygen is to be supplied. Each dispensing unit must: (1) Provide for...

30 CFR 71.603 - Drinking water; dispensing requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Drinking water; dispensing requirements. 71.603... COAL MINES Drinking Water § 71.603 Drinking water; dispensing requirements. (a) Water shall be dispensed through a drinking fountain or from a water storage container with an adequate supply of single...

30 CFR 71.603 - Drinking water; dispensing requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Drinking water; dispensing requirements. 71.603... COAL MINES Drinking Water § 71.603 Drinking water; dispensing requirements. (a) Water shall be dispensed through a drinking fountain or from a water storage container with an adequate supply of single...

30 CFR 71.603 - Drinking water; dispensing requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Drinking water; dispensing requirements. 71.603... COAL MINES Drinking Water § 71.603 Drinking water; dispensing requirements. (a) Water shall be dispensed through a drinking fountain or from a water storage container with an adequate supply of single...

46 CFR 105.05-1 - Commercial fishing vessels dispensing petroleum products.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Commercial fishing vessels dispensing petroleum products... MISCELLANEOUS VESSELS COMMERCIAL FISHING VESSELS DISPENSING PETROLEUM PRODUCTS Application § 105.05-1 Commercial fishing vessels dispensing petroleum products. (a) The provisions of this part, with the exception of...

46 CFR 105.05-1 - Commercial fishing vessels dispensing petroleum products.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Commercial fishing vessels dispensing petroleum products... MISCELLANEOUS VESSELS COMMERCIAL FISHING VESSELS DISPENSING PETROLEUM PRODUCTS Application § 105.05-1 Commercial fishing vessels dispensing petroleum products. (a) The provisions of this part, with the exception of...

46 CFR 105.05-1 - Commercial fishing vessels dispensing petroleum products.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Commercial fishing vessels dispensing petroleum products... MISCELLANEOUS VESSELS COMMERCIAL FISHING VESSELS DISPENSING PETROLEUM PRODUCTS Application § 105.05-1 Commercial fishing vessels dispensing petroleum products. (a) The provisions of this part, with the exception of...

21 CFR 888.4200 - Cement dispenser.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cement dispenser. 888.4200 Section 888.4200 Food... DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4200 Cement dispenser. (a) Identification. A cement dispenser is a nonpowered syringe-like device intended for use in placing bone cement (§ 888.3027) into...

46 CFR 105.45-1 - Loading or dispensing petroleum products.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Loading or dispensing petroleum products. 105.45-1... VESSELS COMMERCIAL FISHING VESSELS DISPENSING PETROLEUM PRODUCTS Special Operating Requirements § 105.45-1 Loading or dispensing petroleum products. (a) A commercial fishing vessel must have aboard a letter of...

46 CFR 105.45-1 - Loading or dispensing petroleum products.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Loading or dispensing petroleum products. 105.45-1... VESSELS COMMERCIAL FISHING VESSELS DISPENSING PETROLEUM PRODUCTS Special Operating Requirements § 105.45-1 Loading or dispensing petroleum products. (a) A commercial fishing vessel must have aboard a letter of...

Potable water dispenser

NASA Technical Reports Server (NTRS)

Cunningham, H. R. (Inventor)

1973-01-01

A dispenser particularly suited for use in dispensing potable water into food and beverage reconstitution bags is described. The dispenser is characterized by an expansible chamber, selectively adjustable stop means for varying the maximum dimensions, a rotary valve, and a linear valve coupled in a cooperating relation for delivering potable water to and from the chamber.

Utilization of triptans in Sweden; analyses of over the counter and prescription sales.

PubMed

von Euler, Mia; Keshani, Sara; Baatz, Katarina; Wettermark, Bjorn

2014-12-01

To enable easier access to triptans, the drug of choice for moderate to severe migraine, some countries have made triptans available without prescription, that is, over the counter (OTC). Concern has been raised about this. The aim of this study was to describe the utilization pattern of triptans in Sweden before and after the OTC switch. Wholesaler and aggregated sales data from all Swedish pharmacies 1991 to 2011 and patient identity data on dispensed prescriptions 2007 and 2011 from the Swedish National Prescribed Drug Register were used to investigate volume and expenditure of triptans. The databases contain complete data for all drugs sold in Sweden or dispensed to all Swedish inhabitants (9.5 million in 2012). Volumes of triptans have increased to 7.0 million defined daily doses (DDD) on prescriptions and 0.7 million DDDs OTC in 2011. Prescriptions were dispensed to 10.0 and 10.1 per 1000 inhabitants in 2007 and 2011, respectively. Although half of those dispensed triptans in 2007 were not in 2011, the incidence remained stable at 2.8 patients per thousand person-years. In 2011, the 10% of the heaviest users accounted for 44% and 48% of dispensed triptans in women and men, respectively. Triptans OTC and the volumes dispensed on prescription have increased as has the DDD per patient purchasing triptans on prescription. However, the number of patient's dispensed triptans on prescription has remained stable. A concern is that almost half of prescribed triptans are purchased by 10% of the users. Copyright © 2014 John Wiley & Sons, Ltd.

Osteoporosis medication dispensing for older Australian women from 2002 to 2010: influences of publications, guidelines, marketing activities and policy.

PubMed

Peeters, Geeske; Tett, Susan E; Duncan, Emma L; Mishra, Gita D; Dobson, Annette J

2014-12-01

Developments in anti-osteoporosis medications (AOMs) have led to changes in guidelines and policy, which, along with media and marketing strategies, have had an impact upon the prescribing of AOM. The aim was to examine patterns of AOM dispensing in older women (aged 76-81 years at baseline) from 2002 to 2010. Administrative claims data were used to describe AOM dispensing in 4649 participants (born in 1921-1926 and still alive in 2011) in the Australian Longitudinal Study on Women's Health. The patterns were interpreted in the context of changes in guidelines, indications for subsidy, publications (scholarly and general media), and marketing activities. Total use of AOM increased from 134 DDD/1000/day in 2002 to 216 DDD/1000/day in 2007 but then decreased to 184 DDD/1000/day in 2010. Alendronate was the most commonly dispensed AOM but decreased from 2007, while use of risedronate (2002 onward), strontium ranelate (2007 onward) and zoledronic acid (2008 onward) increased. Etidronate and hormone replacement therapy (HRT) prescriptions gradually decreased over time. The decline in alendronate dispensing coincided with increases of other bisphosphonates and publicity about potential adverse effects of bisphosphonates, despite relaxing indications for bone density testing and subsidy for AOM. Overall dispense of AOM from 2002 reached a peak in 2007 and thereafter declined despite increases in therapeutic options and improved subsidised access. The recent decline in overall AOM dispensing seems to be explained largely by negative publicity rather than specific changes in guidelines and policy. Copyright © 2014 John Wiley & Sons, Ltd.

Understanding vs. Competency: The Case of Accuracy Checking Dispensed Medicines in Pharmacy

ERIC Educational Resources Information Center

James, K. Lynette; Davies, J. Graham; Kinchin, Ian; Patel, Jignesh P.; Whittlesea, Cate

2010-01-01

Ensuring the competence of healthcare professionals' is core to undergraduate and post-graduate education. Undergraduate pharmacy students and pre-registration graduates are required to demonstrate competence at dispensing and accuracy checking medicines. However, competence differs from understanding. This study determined the competence and…

Attitudes of community pharmacists to antibiotic dispensing and microbial resistance: a qualitative study in Portugal.

PubMed

Roque, Fátima; Soares, Sara; Breitenfeld, Luiza; López-Durán, Ana; Figueiras, Adolfo; Herdeiro, Maria Teresa

2013-06-01

The inappropriate use of antibiotics is considered a main cause of microbial resistance. This is an important public health problem. Community pharmacists have an important role in the management of drugs for outpatients. Our study sought to explore pharmacists' knowledge, attitudes, perceptions and dispensing habits insofar as to antibiotics and microbial resistance. The study was developed with community pharmacists in the North of Portugal. Qualitative research in the form of focus groups (FG). Focus groups were conducted with 4-7 pharmacists, using a moderator. A topic guide was developed to lead the discussions, which were audio-recorded and transcribed. The study was carried out between December 2010 and March 2011 in the five districts of the Northern Health Region of Portugal (ARS-N). Pharmacists from different regions of each district were invited to participate in the study by an investigator responsible for the study. Participants were informed about the study and that sessions were audio-recorded to facilitate data interpretation. They signed an informed consent form before taking part in the focus groups. The Ethical Committee of ARS-N was informed of this study. Pharmacists' knowledge and perceptions on antibiotic use and microbial resistance, attitudes related to antibiotic dispensing habits, and pharmacists' suggestions to improve antibiotic use. A total of 6 focus groups were conducted with community pharmacists (n = 32). Attitudes related to the problem of resistance were attributed external responsibility, to patients, to physicians, to other pharmacies, and to veterinary consumption. Some attitudes were identified that could lead to antibiotic dispensing without a prescription. These attitudes are complacency, precaution and external complacency. Portuguese pharmacists perceive that antibiotic use and bacterial resistance could be improved, showing a behavioural intention to improve antibiotic dispensing habits.

Comparative Rates of Mortality and Serious Adverse Effects Among Commonly Prescribed Opioid Analgesics.

PubMed

Murphy, David L; Lebin, Jacob A; Severtson, Stevan G; Olsen, Heather A; Dasgupta, Nabarun; Dart, Richard C

2018-03-26

The epidemic of prescription opioid overdose and mortality parallels the dispensing rates of prescription opioids, and the availability of increasingly potent opioid analgesics. The common assumption that more potent opioid analgesics are associated with higher rates of adverse outcomes has not been adequately substantiated. We compared the rate of serious adverse events among commonly prescribed opioid analgesics of varying potency. Serious adverse events (SAEs; defined as death, major medical effect, or hospitalization) resulting from exposure to tablets containing seven opioid analgesics (oxycodone, hydrocodone, morphine, hydromorphone, oxymorphone, tapentadol, and tramadol) captured by the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS ® ) System Poison Center Program were evaluated from 2010 through 2016. Rates of SAEs were adjusted for availability through outpatient dispensing data and regressed on morphine milligram equivalents (MME). There were 19,480 cases of SAE during the 7-year study period. Hydrocodone and oxycodone contributed to 77% of SAE cases. Comparing rates of outcome by relative potency, a hierarchy was observed with hydromorphone (8.02 SAEs/100 kg) and tapentadol (0.27 SAE/100 kg) as the highest and lowest rates, reflecting a 30-fold difference among individual opioid products. SAE rate and potency were related linearly-SAEs increased 2.04 per 100 kg drug dispensed for each 1-unit rise in MME (p = 0.004). Linear regression of SAE/100 kg drug dispensed and drug potency identified that MME comprised 96% of the variation observed. In contrast, potency did not explain variation seen using other study denominators (prescriptions dispensed, dosage units dispensed, and the number of individuals filling a prescription). Potency of a prescription opioid analgesic demonstrates a significant, highly positive linear relationship with exposures resulting in SAEs per 100 kg drug dispensed reported to poison centers. Potency should be carefully considered from both individual provider and public health perspectives.

Population prevalence of high dose paracetamol in dispensed paracetamol/opioid prescription combinations: an observational study

PubMed Central

2012-01-01

Background Paracetamol (acetaminophen) is generally considered a safe medication, but is associated with hepatotoxicity at doses above doses of 4.0 g/day, and even below this daily dose in certain populations. Methods The Nova Scotia Prescription Monitoring Program (NSPMP) in the Canadian province of Nova Scotia is a legislated organization that collects dispensing information on all out-of-hospital prescription controlled drugs dispensed for all Nova Scotia residents. The NSPMP provided data to track all paracetamol/opioids redeemed by adults in Nova Scotia, from July 1, 2005 to June 30, 2010. Trends in the number of adults dispensed these prescriptions and the numbers of prescriptions and tablets dispensed over this period were determined. The numbers and proportions of adults who filled prescriptions exceeding 4.0 g/day and 3.25 g/day were determined for the one-year period July 1, 2009 to June 30, 2010. Data were stratified by sex and age (<65 versus 65+). Results Both the number of prescriptions filled and the number of tablets dispensed increased over the study period, although the proportion of the adult population who filled at least one paracetamol/opioid prescription was lower in each successive one-year period. From July 2009 to June 2010, one in 12 adults (n = 59,197) filled prescriptions for over 13 million paracetamol/opioid tablets. Six percent (n = 3,786) filled prescriptions that exceeded 4.0 g/day and 18.6% (n = 11,008) exceeded 3.25 g/day of paracetamol at least once. These findings exclude non-prescription paracetamol and paracetamol–only prescribed medications. Conclusions A substantial number of individuals who redeem prescriptions for paracetamol/opioid combinations may be at risk of paracetamol-related hepatotoxicity. Healthcare professionals must be vigilant when prescribing and dispensing these medications in order to reduce the associated risks. PMID:22709372

Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients.

PubMed

Vélez-Díaz-Pallarés, Manuel; Delgado-Silveira, Eva; Carretero-Accame, María Emilia; Bermejo-Vicedo, Teresa

2013-01-01

To identify actions to reduce medication errors in the process of drug prescription, validation and dispensing, and to evaluate the impact of their implementation. A Health Care Failure Mode and Effect Analysis (HFMEA) was supported by a before-and-after medication error study to measure the actual impact on error rate after the implementation of corrective actions in the process of drug prescription, validation and dispensing in wards equipped with computerised physician order entry (CPOE) and unit-dose distribution system (788 beds out of 1080) in a Spanish university hospital. The error study was carried out by two observers who reviewed medication orders on a daily basis to register prescription errors by physicians and validation errors by pharmacists. Drugs dispensed in the unit-dose trolleys were reviewed for dispensing errors. Error rates were expressed as the number of errors for each process divided by the total opportunities for error in that process times 100. A reduction in prescription errors was achieved by providing training for prescribers on CPOE, updating prescription procedures, improving clinical decision support and automating the software connection to the hospital census (relative risk reduction (RRR), 22.0%; 95% CI 12.1% to 31.8%). Validation errors were reduced after optimising time spent in educating pharmacy residents on patient safety, developing standardised validation procedures and improving aspects of the software's database (RRR, 19.4%; 95% CI 2.3% to 36.5%). Two actions reduced dispensing errors: reorganising the process of filling trolleys and drawing up a protocol for drug pharmacy checking before delivery (RRR, 38.5%; 95% CI 14.1% to 62.9%). HFMEA facilitated the identification of actions aimed at reducing medication errors in a healthcare setting, as the implementation of several of these led to a reduction in errors in the process of drug prescription, validation and dispensing.

Metering gun for dispensing precisely measured charges of fluid

NASA Technical Reports Server (NTRS)

Cook, T. A.; Scheibe, H. (Inventor)

1974-01-01

A cyclically operable fluid dispenser for use in dispensing precisely measured charges of potable water aboard spacecraft is described. The dispenser is characterized by (1) a sealed housing adapted to be held within a crewman's palm and coupled with a pressurized source of potable water; (2) a dispensing jet projected from the housing and configured to be received within a crewman's lips; (3) an expansible measuring chamber for measuring charges of drinking water received from the source; (4) and a dispenser actuator including a lever extended from the housing to be digitated for initiating operational cycles, whereby precisely measured charges of potable water selectively are delivered for drinking purposes in a weightless environment.

Hand disinfection in a neonatal intensive care unit: continuous electronic monitoring over a one-year period.

PubMed

Helder, Onno K; van Goudoever, Johannes B; Hop, Wim C J; Brug, Johannes; Kornelisse, René F

2012-10-08

Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Direct observation of hand hygiene compliance is the gold standard but is time consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. The purpose of this study was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation. A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations. A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559-840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol. We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns.

Method and apparatus for producing drops using a drop-on-demand dispenser

DOEpatents

Chen, Alvin U.; Basaran, Osman A.

2003-01-01

A method and apparatus for dispensing fluid from a drop-on-demand (DOD) fluid dispenser. The method involves withdrawing fluid in the dispenser for a first duration of time, followed by a second duration of time during which the fluid is propelled toward the orifice of the dispenser. Following the period during which the fluid is propelled, there is a second withdrawing of the fluid into the dispenser. The duration of the propelling period is shorter than the duration of either the first withdrawing or the second withdrawing. The propelling of the fluid results in the extension of a small tongue of fluid from the meniscus of the fluid. The second withdrawing of the fluid results in a retraction of the meniscus into the passageway such that only the small tongue of fluid separates and is ejected from the dispenser.

How often are spectacle lenses not dispensed as prescribed?

PubMed

Mohan, Kanwar; Sharma, Ashok

2012-01-01

Spectacles are routinely prescribed by the ophthalmologist and dispensed by the opticians. We investigated how frequently the spectacles are not dispensed as prescribed and whether the frequency of inaccurate spectacles would decrease if the patients, at the time of collecting spectacles, ask the optician to verify that the spectacles have been dispensed accurately. We found inaccurate spectacles in about one-third of our patients and incorrect spherocylinders more frequently with an error in the spherical element and cylinder axis. These inaccuracies decreased significantly when patients while collecting spectacles, asked the optician to verify the accuracy of the spectacles dispensed. It is suggested that while prescribing spectacles, the patients should be made aware of the possibility of dispensing errors. To decrease the frequency of incorrect spectacles, the patients while collecting spectacles, should ask the optician to check whether the spectacles have been dispensed accurately.

Parenteral Medication Prescriptions, Dispensing and Administration Habits in Mongolia

PubMed Central

Dorj, Gereltuya; Sunderland, Bruce; Hendrie, Delia; Parsons, Richard

2014-01-01

High levels of injection prescribing were reported in Mongolia. Understanding the factors influencing the injection prescribing is essential to reduce their inappropriate use. The study evaluated the views, experiences and attitudes of community members associated with the prescribing of injections in Mongolia. A structured questionnaire focusing on respondents' characteristics, experiences and views about injections was developed and administered face-to-face to community members in Ulaanbaatar, Mongolia. Standard descriptive statistics were used to summarize demographic data and responses to the questionnaires. Dependant variables were compared using Kruskal-Wallis Tests for independence. Statistical analyses were performed using SPSS Version 21.0. Six hundred participants were approached and the response rate was 79% (n = 474). Almost half of the respondents were aged between 31 and 50 (n = 228, 48.1%) and 40.9% of respondents were male (n = 194). Most respondents were from Ulaanbaatar city (n = 407, 85.7%). All respondents had received injections in the past and 268 (56.5%) had received injection in the past year. The most common reason for having an injection in the past year was reported as treatment of a disease (n = 163, 60.8%), or for administration of vitamins (n = 70, 26.1%). Injections were prescribed by a doctor (n = 353, 74.9%), dispensed by a pharmacist (n = 283, 59.7%) and administered by a nurse (n = 277, 54.9%). Only 16% of all respondents had the expectation of receiving injections when they visited a doctor (n = 77). An important perception regarding injections was that they hastened the recovery process (n = 269, 56.8%). When asked their opinion about therapeutic injections, 40% of all respondents agreed that injections were a better medicine (n = 190) than oral medications, with older respondents strongly agreeing (p<0.001). Based on this total sample, approximately 1891 injections per 1000 patients were administered. The excessive injection use seems to be promoted by inappropriate prescribing, dispensing and administration of medication by doctors and others. PMID:25531766

21 CFR 872.3080 - Mercury and alloy dispenser.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Mercury and alloy dispenser. 872.3080 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3080 Mercury and alloy dispenser. (a) Identification. A mercury and alloy dispenser is a device with a spring-activated valve intended to measure and...

21 CFR 872.3080 - Mercury and alloy dispenser.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Mercury and alloy dispenser. 872.3080 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3080 Mercury and alloy dispenser. (a) Identification. A mercury and alloy dispenser is a device with a spring-activated valve intended to measure and...

21 CFR 872.3080 - Mercury and alloy dispenser.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Mercury and alloy dispenser. 872.3080 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3080 Mercury and alloy dispenser. (a) Identification. A mercury and alloy dispenser is a device with a spring-activated valve intended to measure and...

21 CFR 872.3080 - Mercury and alloy dispenser.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Mercury and alloy dispenser. 872.3080 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3080 Mercury and alloy dispenser. (a) Identification. A mercury and alloy dispenser is a device with a spring-activated valve intended to measure and...

21 CFR 1307.11 - Distribution by dispenser to another practitioner or reverse distributor.

Code of Federal Regulations, 2010 CFR

2010-04-01

... practitioner who is registered to dispense a controlled substance may distribute (without being registered to distribute) a quantity of such substance to— (1) Another practitioner for the purpose of general dispensing... is to be distributed is registered under the Act to dispense that controlled substance; (ii) The...

14 CFR 25.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Equipment standards for oxygen dispensing... § 25.1447 Equipment standards for oxygen dispensing units. If oxygen dispensing units are installed... supplemental oxygen is to be supplied. Units must be designed to cover the nose and mouth and must be equipped...

14 CFR 25.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Equipment standards for oxygen dispensing... § 25.1447 Equipment standards for oxygen dispensing units. If oxygen dispensing units are installed... supplemental oxygen is to be supplied. Units must be designed to cover the nose and mouth and must be equipped...

14 CFR 25.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Equipment standards for oxygen dispensing... § 25.1447 Equipment standards for oxygen dispensing units. If oxygen dispensing units are installed... supplemental oxygen is to be supplied. Units must be designed to cover the nose and mouth and must be equipped...

14 CFR 25.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Equipment standards for oxygen dispensing... § 25.1447 Equipment standards for oxygen dispensing units. If oxygen dispensing units are installed... supplemental oxygen is to be supplied. Units must be designed to cover the nose and mouth and must be equipped...

14 CFR 25.1447 - Equipment standards for oxygen dispensing units.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Equipment standards for oxygen dispensing... § 25.1447 Equipment standards for oxygen dispensing units. If oxygen dispensing units are installed... supplemental oxygen is to be supplied. Units must be designed to cover the nose and mouth and must be equipped...

Co-possession of phosphodiesterase type-5 inhibitors (PDE5-I) with nitrates.

PubMed

Chang, Li-Ling; Ma, Mark; Allmen, Heather von; Henderson, Scott C; Harper, Kristine; Hornbuckle, Kenneth

2010-06-01

Estimate the proportion of phosphodiesterase type-5 inhibitor (PDE5-I) patients who co-possess nitrates and compare the proportion of tadalafil patients dispensed nitrates to a matched control group. Secondarily, examine the percentage of co-possession of PDE5-Is and nitrates where the products were dispensed on the same day or written by the same prescriber. Male patients aged 18+ years filling PDE5-I prescriptions between December 2003 and March 2006 were identified using a U.S. longitudinal prescription database (IMS Health LRx). Similar patients not dispensed a PDE5-I during this period were matched to the tadalafil-dispensed cohort using a propensity score approach. Co-possession, as a proxy for concurrent use, was defined as an overlap in time on therapy for a PDE5-I and nitrate and was compared for the three PDE5-Is and for tadalafil to the matched control group. Among 601,063 tadalafil patients, 3.31% were dispensed a nitrate during the study period, compared to 6.18% in control patients (n = 601,063). When co-possessed prescriptions were defined by overlapping exposure periods, the proportion of PDE5-I patients with co-possessed nitrates ranged from 1.44% (tadalafil) to 1.72% (vardenafil) and 2.13% (sildenafil). Co-possession percentages of PDE5-I prescriptions were 0.83% for tadalafil and 1.07% for sildenafil and vardenafil. The majority (54.29%) of co-possessed PDE5-I and nitrate prescriptions had the nitrate dispensed prior to the PDE5-I prescription identified in the study cohort. Keeping in mind the limitations of observational studies, these results suggest that co-dispensing of nitrates and PDE5-Is is low. Compared to control patients, the proportion of nitrate co-possession was lowest for patients filling tadalafil. Tadalafil patients also had the lowest co-possessed proportion among the three PDE5-I cohorts. While the majority of co-possessed drug pairs were prescribed by different providers, the highest percentage of co-prescribing from the same physician was among cardiologists. These results suggest that physicians adhere to contraindications and are careful about co-prescribing of nitrates with PDE-5Is.

Consumer Choice of E85 Denatured Ethanol Fuel Blend: Price Sensitivity and Cost of Limited Fuel Availability

DOE PAGES

Liu, Changzheng; Greene, David

2014-12-01

The promotion of greater use of E85, a fuel blend of 85% denatured ethanol, by flex-fuel vehicle owners is an important means of complying with the Renewable Fuel Standard 2. A good understanding of factors affecting E85 demand is necessary for effective policies that promote E85 and for developing models that forecast E85 sales in the United States. In this paper, the sensitivity of aggregate E85 demand to E85 and gasoline prices is estimated, as is the relative availability of E85 versus gasoline. The econometric analysis uses recent data from Minnesota, North Dakota, and Iowa. The more recent data allowmore » a better estimate of nonfleet demand and indicate that the market price elasticity of E85 choice is substantially higher than previously estimated.« less

77 FR 70141 - Application(s) for Duty-Free Entry of Scientific Instruments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-23

... Institute, 4000 Jones Bridge Rd., Chevy Chase, MD 20815. Instrument: Micro-litre and nanolitre dispensing...-litre and nanolitre dispensing system. Manufacturer: TTP Labtech Ltd, United Kingdom. Intended Use: The...: The instrument will be used to study biomaterials such as starches, lignin, and proteins, and compare...

The human Ino80 binds to microtubule via the E-hook of tubulin: Implications for the role in spindle assembly

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, Eun-Jung; Hur, Shin-Kyoung; Lee, Han-Sae

2011-12-16

Highlights: Black-Right-Pointing-Pointer The N-terminal domain of hIno80 is important for binding to the spindle. Black-Right-Pointing-Pointer The hIno80 N-terminal domain binds to tubulin and microtubule in vitro. Black-Right-Pointing-Pointer The E-hook of tubulin is critical for hIno80 binding to tubulin and microtubule. Black-Right-Pointing-Pointer Tip49a does not bind to microtubule and dispensable for spindle formation. -- Abstract: The human INO80 chromatin remodeling complex, comprising the Ino80 ATPase (hIno80) and the associated proteins such as Tip49a, has been implicated in a variety of nuclear processes other than transcription. We previously have found that hIno80 interacts with tubulin and co-localizes with the mitotic spindle andmore » is required for spindle formation. To better understand the role of hIno80 in spindle formation, we further investigated the interaction between hIno80 and microtubule. Here, we show that the N-terminal domain, dispensable for the nucleosome remodeling activity, is important for hIno80 to interact with tubulin and co-localize with the spindle. The hIno80 N-terminal domain binds to monomeric tubulin and polymerized microtubule in vitro, and the E-hook of tubulin, involved in the polymerization of microtubule, is critical for this binding. Tip49a, which has been reported to associate with the spindle, does not bind to microtubule in vitro and dispensable for spindle formation in vivo. These results suggest that hIno80 can play a direct role in the spindle assembly independent of its chromatin remodeling activity.« less

Trends in Statin Use in Seniors 1999 to 2013: Time Series Analysis.

PubMed

Minard, Laura V; Corkum, Amber; Sketris, Ingrid; Fisher, Judith; Zhang, Ying; Saleh, Ahmed

2016-01-01

To examine HMG-CoA reductase inhibitor (statin) drug dispensing patterns to Nova Scotia Seniors' Pharmacare program (NSSPP) beneficiaries over a 14-year period in response to: 1) rosuvastatin market entry in 2003, 2) JUPITER trial publication in 2008, and 3) generic atorvastatin availability in 2010. All NSSPP beneficiaries who redeemed at least one prescription for a statin from April 1, 1999 to March 31, 2013 were included. Aggregated, anonymous monthly prescription counts were extracted by the Nova Scotia Department of Health and Wellness (Nova Scotia, Canada) and changes in dispensing patterns of statins were measured. Data were analyzed using descriptive analyses and interrupted time series methods. The percentage of NSSPP beneficiaries dispensed any statin increased from 5.3% in April 1999 to 20.7% in March 2013. In 1999, most NSSPP beneficiaries were dispensed either simvastatin (29.5%) or atorvastatin (28.7%). When rosuvastatin was added to the NSSPP Formulary in August 2003, prescriptions dispensed for simvastatin, lovastatin, pravastatin, and fluvastatin declined significantly (slope change, -0.0027; 95% confidence interval (CI), (-0.0046, -0.0009)). This significant decline continued following the publication of JUPITER (level change, -0.1974; 95% CI, (-0.2991, -0.0957)) and the availability of generic atorvastatin (level change, -0.2436; 95% CI, (-0.3314, -0.1558)). Atorvastatin was not significantly affected by any of the three interventions, although it maintained an overall decreasing trend. Only upon the availability of generic atorvastatin did the upward trend in rosuvastatin use decrease significantly (slope change, -0.0010, 95% CI, (-0.0015, -0.0005)). The type and rate of statins dispensed to NSSPP beneficiaries changed from 1999 to 2013 in response to the availability of new agents and publication of the JUPITER trial. The overall proportion of NSSPP beneficiaries dispensed a statin increased approximately 4-fold during the study period. In 2013, rosuvastatin was the most commonly dispensed statin (44.1%) followed by atorvastatin (39.1%).

The potential of pigeons as surrogate observers in medical image perception studies

NASA Astrophysics Data System (ADS)

Krupinski, Elizabeth A.; Levenson, Richard M.; Navarro, Victor; Wasserman, Edward A.

2016-03-01

Assessment of medical image quality and how changes in image appearance impact performance are critical but assessment can be expensive and time-consuming. Could an animal (pigeon) observer with well-known visual skills and documented ability to distinguish complex visual stimuli serve as a surrogate for the human observer? Using sets of whole slide pathology (WSI) and mammographic images we trained pigeons (cohorts of 4) to detect and/or classify lesions in medical images. Standard training methods were used. A chamber equipped with a 15' display with a resistive touchscreen was used to display the images and record responses (pecks). Pigeon pellets were dispensed for correct responses. The pigeons readily learned to distinguish benign from malignant breast cancer histopathology in WSI (mean % correct responses rose 50% to 85% over 15 days) and generalized readily from 4X to 10X and 20X magnifications; to detect microcalcifications (mean % correct responses rose 50% to over 85% over 25 days); to distinguish benign from malignant breast masses (3 of 4 birds learned this task to around 80% and 60% over 10 days); and ignore compression artifacts in WSI (performance with uncompressed slides averaged 95% correct; 15:1 and 27:1 compression slides averaged 92% and 90% correct). Pigeons models may help us better understand medical image perception and may be useful in quality assessment by serving as surrogate observers for certain types of studies.

Ecologic analysis of asthma-related events and dispensing of inhaled corticosteroid- and salmeterol-containing products.

PubMed

DiSantostefano, Rachael L; Davis, Kourtney J; Yancey, Steve; Crim, Courtney

2008-06-01

An association between salmeterol use and serious asthma episodes or asthma-related mortality has been noted in 2 clinical trials; however, a causal relationship has not been established. To date, observational studies have not replicated this finding. To examine the relationship between number of prescriptions dispensed of salmeterol-containing products and inhaled corticosteroid (ICS)-containing products and the rates of asthma-related hospitalizations and mortality in the United States. In this ecologic study, annual age-adjusted rates of asthma-related hospitalization and asthma-related mortality from US population-based sources were graphed alongside annual number of prescriptions dispensed of salmeterol- and ICS-containing products by year from 1991 to 2004. We computed the Spearman rank correlations between number of prescriptions dispensed and serious events (asthma-related hospitalization rate, number of hospitalizations, asthma-related mortality rate, and number of asthma deaths). During more than 14 years, while number of prescriptions dispensed of salmeterol-containing and ICS-containing products increased, age-adjusted asthma-related mortality rates declined and asthma-related hospitalization rates remained relatively stable. The number of asthma-related deaths has decreased steadily since the mid-1990s. This study provides population-level evidence that asthma-related death rates declined and asthma-related hospitalization rates remained relatively constant for more than 14 years during a period of improvements in asthma management per treatment guidelines, including increased use of maintenance medications, such as ICSs and salmeterol.

Automatic fluid dispenser

NASA Technical Reports Server (NTRS)

Sakellaris, P. C. (Inventor)

1977-01-01

Fluid automatically flows to individual dispensing units at predetermined times from a fluid supply and is available only for a predetermined interval of time after which an automatic control causes the fluid to drain from the individual dispensing units. Fluid deprivation continues until the beginning of a new cycle when the fluid is once again automatically made available at the individual dispensing units.

Structure Design and Realization of Rapid Medicine Dispensing System

NASA Astrophysics Data System (ADS)

Liu, Xiangquan

In this paper, the main components and function of rapid medicine dispensing system is analyzed, structure design of automatic feeding device, sloping storeroom, automatic dispensing device and automatic sorting device is completed. The system adopts medicine conveyer working in with manipulator to realize automatic batch supply of the boxed medicine, adopts sloping storeroom as warehouse of medicine to realize dense depositing, adopts dispensing mechanism which includes elevator, turning panel and electric magnet to realize rapid medicine dispensing, adopts sorting conveyor belt and sorting device to send medicine to designated outlet.

Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014.

PubMed

Mercado, Melissa C; Sumner, Steven A; Spelke, M Bridget; Bohm, Michele K; Sugerman, David E; Stanley, Christina

2018-03-01

This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl. This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467). Illicit-fentanyl decedents were younger than other drug decedents (P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances (P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents' opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders. Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids.

Electronic vending machines for dispensing rapid HIV self-testing kits: a case study.

PubMed

Young, Sean D; Klausner, Jeffrey; Fynn, Risa; Bolan, Robert

2014-02-01

This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV self-testing kits in Los Angeles County. Feasibility criteria that needed to be addressed were defined as: (1) ability to find a manufacturer who would allow dispensing of HIV testing kits and could fit them to the dimensions of a vending machine, (2) ability to identify and address potential initial obstacles, trade-offs in choosing a machine location, and (3) ability to gain community approval for implementing this approach in a community setting. To address these issues, we contracted a vending machine company who could supply a customized, Internet-enabled machine that could dispense HIV kits and partnered with a local health center available to host the machine onsite and provide counseling to participants, if needed. Vending machines appear to be feasible technologies that can be used to distribute HIV testing kits.

Pharmacoepidemiological Data from Drug Dispensing Charities as a Measure of Health Patterns in a Population not Assisted by the Italian National Health Service.

PubMed

Bini, Silvia; Cerri, Cesare; Rigamonti, Antonello E; Bertazzi, Pietro A; Fiorini, Gianfrancesco; Cella, Silvano G

2016-08-19

We analysed drug dispensation by charitable organisations in a year time. Drugs were grouped according to the Anatomic Therapeutic Chemical classification and the amount dispensed was calculated with the system of the Daily Defined Dose (DDD) and expressed as DDD/1000 subjects/day. A number of 87,550 subjects were studied (13,308 Italians; 74,242 Immigrants). Though we noticed a great sesonal variability, the drugs most frequently dispensed were those for the respiratory, cardiovascular and gastrointestinal system and antibiotics, which is different from the rest of the Italian population and the immigrant population assisted by our National Health Service (NHS). We also found that chronic diseases are increasing in these subjects. We conclude that the subjects not receiving NHS assitance have, at least in part, different health patterns and requirements. This should be considered when planning tailored interventions.

Electronic vending machines for dispensing rapid HIV self-testing kits: A case study

PubMed Central

Young, Sean D.; Klausner, Jeffrey; Fynn, Risa; Bolan, Robert

2014-01-01

This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV-self testing kits in Los Angeles County. Feasibility criteria that needed to be addressed were defined as: 1) ability to find a manufacturer who would allow dispensing of HIV testing kits and could fit them to the dimensions of a vending machine, 2) ability to identify and address potential initial obstacles, trade-offs in choosing a machine location, and 3) ability to gain community approval for implementing this approach in a community setting. To address these issues, we contracted a vending machine company who could supply a customized, Internet-enabled machine that could dispense HIV kits and partnered with a local health center available to host the machine onsite and provide counseling to participants, if needed. Vending machines appear to be feasible technologies that can be used to distribute HIV testing kits. PMID:23777528

40 CFR 180.1037 - Polybutenes; exemption from the requirement of a tolerance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (1:1 mixture of (Z,Z)- and (Z,E)-7,11-hexadecadien-1-ol acetate) to disrupt the mating of the pink... dispensers of (Z)-11-hexaadecenal to disrupt the mating of the artichoke plume moth. [74 FR 26534, June 3...

Use of prescribed opioid analgesics and co-medication with benzodiazepines in women before, during, and after pregnancy: a population-based cohort study.

PubMed

Handal, Marte; Engeland, Anders; Rønning, Marit; Skurtveit, Svetlana; Furu, Kari

2011-09-01

The aim of the study was to describe the use of prescribed opioid analgesics for noncancer pain and the degree of possible concurrent co-medication with benzodiazepines to women in Norway before, during, and after pregnancy. This was a population-based cohort study based on linkage of two nationwide registries: the Medical Birth Registry of Norway, and the Norwegian Prescription Database. Prescribed opioid analgesics and benzodiazepines issued to women 3 months prior to, during, and 3 months after pregnancies were identified. The study population consisted of 194,937 singleton pregnancies beginning in March 2004 or later and ending before January 2009. About 6% of the women were dispensed opioid analgesics before, during, or after pregnancy. Almost all these women received weak opioids (99%) with short-acting codeine in combination with paracetamol (acetaminophen) as the most frequently dispensed drug. The dispensing of codeine was reduced from 24/1,000 women before pregnancy to 10/1,000 in the last trimester, increasing to 17/1,000 during the breastfeeding period. Most women were dispensed codeine once, and treatment was of short duration (about 1 week). A small group of women (n = 271) were dispensed opioids in all trimesters. Increasing benzodiazepine use was observed as the number of opioid prescriptions increased. The use of opioid analgesics in pregnant women in Norway was dominated by treatment of short duration of the weak opioid codeine. As pregnancy proceeded, opioid use was reduced. However, the increase in opioid use during the nursing period has the potential for serious adverse effects.

Comparison of a hybrid medication distribution system to simulated decentralized distribution models.

PubMed

Gray, John P; Ludwig, Brad; Temple, Jack; Melby, Michael; Rough, Steve

2013-08-01

The results of a study to estimate the human resource and cost implications of changing the medication distribution model at a large medical center are presented. A two-part study was conducted to evaluate alternatives to the hospital's existing hybrid distribution model (64% of doses dispensed via cart fill and 36% via automated dispensing cabinets [ADCs]). An assessment of nurse, pharmacist, and pharmacy technician workloads within the hybrid system was performed through direct observation, with time standards calculated for each dispensing task; similar time studies were conducted at a comparator hospital with a decentralized medication distribution system involving greater use of ADCs. The time study data were then used in simulation modeling of alternative distribution scenarios: one involving no use of cart fill, one involving no use of ADCs, and one heavily dependent on ADC dispensing (89% via ADC and 11% via cart fill). Simulation of the base-case and alternative scenarios indicated that as the modeled percentage of doses dispensed from ADCs rose, the calculated pharmacy technician labor requirements decreased, with a proportionately greater increase in the nursing staff workload. Given that nurses are a higher-cost resource than pharmacy technicians, the projected human resource opportunity cost of transitioning from the hybrid system to a decentralized system similar to the comparator facility's was estimated at $229,691 per annum. Based on the simulation results, it was decided that a transition from the existing hybrid medication distribution system to a more ADC-dependent model would result in an unfavorable shift in staff skill mix and corresponding human resource costs at the medical center.

Trends in nurse practitioners' prescribing to older adults in Ontario, 2000-2010: a retrospective cohort study

PubMed Central

Tranmer, Joan E.; Colley, Lindsey; Edge, Dana S.; Sears, Kim; VanDenKerkhof, Elizabeth; Levesque, Linda

2015-01-01

Background: Nurse prescribing is a practice that has evolved and will continue to evolve in response to emerging trends, particularly in primary care. The goal of this study was to describe the trends and patterns in medication prescription to adults 65 years of age or older in Ontario by nurse practitioners over a 10-year period. Methods: We conducted a population-based descriptive retrospective cohort study. All nurse practitioners registered in the Corporate Provider Database between Jan. 1, 2000, and Dec. 31, 2010, were identified. We identified actively prescribing nurse practitioners through linkage of dispensed medications to people aged 65 years or older from the Ontario Drug Benefit database. For comparison, all prescription medications dispensed by family physicians to a similar group were identified. Geographic location was determined based on site of nurse practitioner practice. Results: The number and proportion of actively prescribing nurse practitioners prescribing to older adults increased during the study period, from 44/340 (12.9%) to 888/1423 (62.4%). The number and proportion of medications dispensed for chronic conditions by nurse practitioners increased: in 2010, 9 of the 10 top medications dispensed were for chronic conditions. There was substantial variation in the proportion of nurse practitioners dispensing medication to older adults across provincial Local Health Integration Networks. Interpretation: Prescribing by nurse practitioners to older adults, particularly of medications related to chronic conditions, increased between 2000 and 2010. The integration of nurse practitioners into primary care has not been consistent across the province and has not occurred in relation to population changes and perhaps population needs. PMID:26457291

Balancing risk and benefit: maintenance of a thawed Group A plasma inventory for trauma patients requiring massive transfusion.

PubMed

Mehr, Chelsea R; Gupta, Rajan; von Recklinghausen, Friedrich M; Szczepiorkowski, Zbigniew M; Dunbar, Nancy M

2013-06-01

Transfusion of plasma and red blood cell (RBC) units in a balanced ratio approximating 1:1 has been shown in retrospective studies to be associated with improved outcomes for trauma patients. Our low-volume rural trauma center uses a trauma-activated transfusion algorithm. Plasma is thawed upon activation to avoid wastage. However, the time required for plasma thawing has made achievement of a 1:1 ratio early in resuscitation challenging. In this study, the time required for plasma thawing is characterized, and a potential solution is proposed. A retrospective chart study of 38 moderately and massively transfused (≥6 U in the first 24 hours) trauma patients admitted from January 2008 to March 2012 was performed. We evaluated the time required to dispense plasma and the number of RBCs dispensed before plasma in these patients. The average time between the dispense of RBCs and plasma was 26 minutes (median, 28; range, 0-48 minutes). The average number of RBCs dispensed before plasma was 8 U (median, 7 U; range, 0-24 U). Nearly one third of massively transfused patients had 10 RBCs or greater dispensed before plasma was available. There exists the potential for delayed plasma availability owing to time required for thawing, which may compromise the ability to provide balanced plasma to RBC transfusion to trauma patients. Maintenance of a thawed Group AB plasma inventory may not be operationally feasible for rural centers with low trauma volumes. Use of a thawed Group A plasma inventory is a potential alternative to ensure rapid plasma availability. Therapeutic study, level V.

[Dispensing prescriptions to persons affiliated with the Seguro Popular de Salud de México].

PubMed

Garrido-Latorre, Francisco; Hernández-Llamas, Héctor; Gómez-Dantés, Octavio

2008-01-01

Measure and compare the percentage of prescriptions fully dispensed to persons with and without Popular Health Insurance (SPS in Spanish) who use ambulatory and general hospital services associated with the Mexico State Health Services (SESA in Spanish), and taking into account insurance status. SESA user satisfaction was also measured with respect to access to medication. Information for the study was taken from four surveys of SESA ambulatory and hospital units that included probabilistic samples with state representativity. Samples of ambulatory units were selected by stratification according to level of care and association to the SPS service network. The findings indicate that the percentage of prescriptions fully dispensed in SESA ambulatory units has improved, reaching approximately 90%, especially among those units offering services to persons affiliated with SPS. Nevertheless, these percentages continue to be lower than those of ambulatory units associated with social security institutions. Percentages of prescriptions fully dispensed have also improved in SESA hospital units, but continue to be relatively low. In nearly all states, as the percentage of prescriptions fully dispensed has increased, user satisfaction with access to medication has also improved. In 2006 more than 50% of the states had high levels of fully dispensed prescriptions among persons with SPS (> or =90%). The more significant problem exists among hospitals, since only 44% of users who received a prescription in SESA hospitals in 2006 had their prescriptions fully dispensed. This finding requires a review of SPS medication policies, which have favored highly prescribed low-cost medications at ambulatory services at the expense of higher cost and more therapeutically effective medications for hospital care, the latter having a greater impact on household budgets.

Isolation of Raoultella planticola from refillable antimicrobial liquid soap dispensers in a dental setting.

PubMed

Momeni, Stephanie S; Tomlin, Nancy; Ruby, John D

2015-04-01

Liquid antimicrobial soaps are commonly used in the dental health care setting for hand washing to minimize the potential spread of infectious agents to health care workers and patients. The purpose of the current study was to evaluate possible bacterial contamination of antimicrobial liquid soap dispensers located in 2 institutional comprehensive dental care clinics. Fourteen soap dispensers and 16 original stock containers were sampled. A 1-milliliter aliquot was diluted in 10 mL of phosphate buffer (Tween-80; Acros). Serial dilutions were plated in duplicate on neutralizing agar and incubated for 7 days. Molecular identification was performed using 500 base pair comparisons of 16S ribosomal ribonucleic acid sequencing. Taq polymerase chain reaction was performed with sequence-specific primers for Raoultella species. Bacterial growth was observed at 18 hours for 57% (8 of 14) of soap dispenser samples. Bacterial densities ranged from 4 × 10(2) to 6 × 10(9) colony-forming units per milliliter. Original commercial containers exhibited no growth. Isolates were identified as Raoultella (Klebsiella) planticola. This is the first study to the authors' knowledge indicating recovery of R. planticola from antimicrobial liquid soap dispensers. R. planticola is a recognized environmental opportunistic pathogen that potentially poses a health concern. These findings indicate compliance problems with infection prevention recommendations and support the US Centers for Disease Control and Prevention's recommendation that dispensers should not be topped off. High bacterial loads of R. planticola are inconsistent with infection control practices and are a concern because transmission and possible infection to the health care worker or the patient may occur. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Herbal Medicines: Personal Use, Knowledge, Attitude, Dispensing Practice, and the Barriers among Community Pharmacists in Gondar, Northwest Ethiopia

PubMed Central

Birarra, Mequanent Kassa

2017-01-01

Background Herbal medicine use is increasing and the global market is estimated to be US$107 billion by the year 2017. Objectives This study aimed at assessing community pharmacists' personal use, knowledge, attitude, dispensing practice, and the barriers regarding herbal medicines. Methods Institution based cross-sectional study was conducted among 47 community pharmacists in Gondar, Northwest Ethiopia, using a structured interviewing questionnaire. Results Nearly half of the respondents (n = 22, 46.8%) sometimes use herbal medicines. Although knowledge related to such preparations was self-rated as poor/acceptable (n = 34, 72.4%), majority (n = 44, 93.7%) of community pharmacists agree/strongly agree that herbal medicines have beneficial effects. Only 6 (12.7%) of them are sometimes/often engaged in dispensing herbal medicines and most of them (n = 34, 72.3%) rarely/never counseled clients regarding these preparations. Limited knowledge on and access to information regarding herbal medicines are the main barriers to the pharmacists' practice. Conclusion Although community pharmacists in Gondar, Northwest Ethiopia, commonly use and demonstrated good attitude towards herbal medicines, they are less involved in dispensing such products. They are also challenged with limited knowledge on and access to herbal medicine information. Thus, pharmacy educators, professional organizations, and the government shall pay more attention to solve the problem. Regulatory provisions on herbal medicine dispensing must be enacted and communicated very well. PMID:28904558

Herbal Medicines: Personal Use, Knowledge, Attitude, Dispensing Practice, and the Barriers among Community Pharmacists in Gondar, Northwest Ethiopia.

PubMed

Asmelashe Gelayee, Dessalegn; Binega Mekonnen, Gashaw; Asrade Atnafe, Seyfe; Birarra, Mequanent Kassa; Asrie, Assefa Belay

2017-01-01

Herbal medicine use is increasing and the global market is estimated to be US$107 billion by the year 2017. This study aimed at assessing community pharmacists' personal use, knowledge, attitude, dispensing practice, and the barriers regarding herbal medicines. Institution based cross-sectional study was conducted among 47 community pharmacists in Gondar, Northwest Ethiopia, using a structured interviewing questionnaire. Nearly half of the respondents ( n = 22, 46.8%) sometimes use herbal medicines. Although knowledge related to such preparations was self-rated as poor/acceptable ( n = 34, 72.4%), majority ( n = 44, 93.7%) of community pharmacists agree/strongly agree that herbal medicines have beneficial effects. Only 6 (12.7%) of them are sometimes/often engaged in dispensing herbal medicines and most of them ( n = 34, 72.3%) rarely/never counseled clients regarding these preparations. Limited knowledge on and access to information regarding herbal medicines are the main barriers to the pharmacists' practice. Although community pharmacists in Gondar, Northwest Ethiopia, commonly use and demonstrated good attitude towards herbal medicines, they are less involved in dispensing such products. They are also challenged with limited knowledge on and access to herbal medicine information. Thus, pharmacy educators, professional organizations, and the government shall pay more attention to solve the problem. Regulatory provisions on herbal medicine dispensing must be enacted and communicated very well.

How much information about the benefits of medicines is included in patient leaflets in the European Union? - A survey.

PubMed

Dickinson, Rebecca; Raynor, David K; Knapp, Peter; MacDonald, Jan

2017-04-01

Patient information leaflets (PILs) are required with all licensed medicines throughout the European Union (EU) and they must include information about all side effects and their likelihood. This has led to criticism of a lack of balance, with little information included about potential benefits. Recent European Medicines Agency guidance proposed the inclusion of benefit information, and this study examined the current prevalence and type of such information in PILs in the EU. A survey and content analysis of the English translation of PILs in the EUwas carried out. Random quota sampling was used on the most frequently dispensed (n = 50) and newly licensed medicines (n = 50) in 2011/2. Leaflets were searched for benefit information meeting predefined criteria, and data synthesised and categorised into 10 categories. Eighty-five (85%) leaflets described how the medicine works, with 45 providing information about the rationale for treatment (more commonly for newly licensed (32/50) than most commonly dispensed medicines (13/50; P < 0.001). Nearly half (47) did not describe whether the medicine was curative, symptomatic or preventative. The terms used to communicate uncertainty were imprecise (such as 'may help'). None communicated numerical benefit information. Current PILs do not appropriately communicate information about benefit. At the basic level, around a half did not include information about treatment rationale or whether the treatment was to treat symptoms, curative or preventative. However, for true informed decision making, patients need quantitative information about benefits and none of the leaflets provided this. © 2016 Royal Pharmaceutical Society.

Investigation of thermal degradation with extrusion-based dispensing modules for 3D bioprinting technology.

PubMed

Lee, Hyungseok; Yoo, James J; Kang, Hyun-Wook; Cho, Dong-Woo

2016-02-04

Recently, numerous three-dimensional (3D) bioprinting systems have been introduced for the artificial regeneration of tissues. Among them, the extrusion-based dispensing module is the most widely used because of the processability it gives various biomaterials. The module uses high forces and temperature to dispense materials through a micro-nozzle. Generally, the harsh conditions induce thermal degradation of the material in the dispensing procedure. The thermal degradation affects the properties of the materials, and the change of the properties should be carefully controlled, because it severely affects the regeneration of tissues. Therefore, in this research, the relationship between the dispensing module and the thermal degradation of material was investigated. Extrusion-based dispensing modules can be divided into the syringe type (ST) and filament type (FT) based on working principles. We prepared a poly lactic-co-glycolic acid (PLGA) scaffold with the two methods at various time points. Then, the characteristics of the printed scaffolds were assessed by measuring molecular weight (M w), glass transition temperature (T g), in vitro degradation, compressive modulus, and cytocompatibility. The results showed that the PLGA scaffold with the FT dispensing module maintained its properties regardless of printing time points. In contrast, severe thermal degradation was observed in the scaffold group prepared by the ST dispensing module. Consequentially, it was obvious that the FT dispensing module was more suitable for producing scaffolds without severe thermal degradation.

Alternative Fuels Data Center: CNG Vehicle Fueling Animation Text Version

Science.gov Websites

- Gas rapidly cools CNG moves rapidly from the dispenser (high pressure) into the fuel tank (low off when the liquid reaches the top of the tank, a CNG dispenser stops when it reaches a certain rise. 5 minutes - Dispenser shuts off, operator disconnects The dispenser stops filling when it reaches

Office dispensing: a responsible approach.

PubMed

Farris, P K

2000-09-01

Office dispensing is a value added service in the dermatologist's office. As dermatologists we can recommend products with known scientific validity that will enhance patient care and provide reliable therapeutic results. Patients enjoy the convenience of being able to purchase products in the office and appreciate the dermatologist who spends time outlining a daily skin care regimen. Office dispensing benefits the physician by forcing him or her to keep current on new innovations in skin care and serves as an effective way to develop your cosmetic practice. Antiaging products, moisturizers and sunscreens, cleansers, and acne products are the basics for any in-office dispensing operation. The addition of hair and nail care products constitutes more advanced dispensing. Despite the mutual benefits for both the patient and physician, office dispensing continues to be controversial. The American Medical Association is concerned that selling health-related goods in the office may compromise the patient-physician relationship. The American Academy of Dermatology continues to support the right of dermatologists to dispense products in their office as long as it is in the best interest of the patient, as it is with all other dermatologic care. Dermatologists must preserve the right to dispense by conducting themselves in a highly professional and ethical manner.

Design and Fabrication of a MEMS Flow Sensor and Its Application in Precise Liquid Dispensing

PubMed Central

Liu, Yaxin; Chen, Liguo; Sun, Lining

2009-01-01

A high speed MEMS flow sensor to enhance the reliability and accuracy of a liquid dispensing system is proposed. Benefitting from the sensor information feedback, the system can self-adjust the open time of the solenoid valve to accurately dispense desired volumes of reagent without any pre-calibration. First, an integrated high-speed liquid flow sensor based on the measurement of the pressure difference across a flow channel is presented. Dimensions of the micro-flow channel and two pressure sensors have been appropriately designed to meet the static and dynamic requirements of the liquid dispensing system. Experiments results show that the full scale (FS) flow measurement ranges up to 80 μL/s, with a nonlinearity better than 0.51% FS. Secondly, a novel closed-loop control strategy is proposed to calculate the valve open time in each dispensing cycle, which makes the system immune to liquid viscosity, pressure fluctuation, and other sources of error. Finally, dispensing results show that the system can achieve better dispensing performance, and the coefficient of variance (CV) for liquid dispensing is below 3% at 1 μL and below 4% at 100 nL. PMID:22408517

Design and Fabrication of a MEMS Flow Sensor and Its Application in Precise Liquid Dispensing.

PubMed

Liu, Yaxin; Chen, Liguo; Sun, Lining

2009-01-01

A high speed MEMS flow sensor to enhance the reliability and accuracy of a liquid dispensing system is proposed. Benefitting from the sensor information feedback, the system can self-adjust the open time of the solenoid valve to accurately dispense desired volumes of reagent without any pre-calibration. First, an integrated high-speed liquid flow sensor based on the measurement of the pressure difference across a flow channel is presented. Dimensions of the micro-flow channel and two pressure sensors have been appropriately designed to meet the static and dynamic requirements of the liquid dispensing system. Experiments results show that the full scale (FS) flow measurement ranges up to 80 μL/s, with a nonlinearity better than 0.51% FS. Secondly, a novel closed-loop control strategy is proposed to calculate the valve open time in each dispensing cycle, which makes the system immune to liquid viscosity, pressure fluctuation, and other sources of error. Finally, dispensing results show that the system can achieve better dispensing performance, and the coefficient of variance (CV) for liquid dispensing is below 3% at 1 μL and below 4% at 100 nL.

Birds Bug on Indirect Plant Defenses to Locate Insect Prey.

PubMed

Hiltpold, Ivan; Shriver, W Gregory

2018-06-01

It has long been thought that most birds do not use volatile cues to perceive their environment. Aside from some scavenging birds, this large group of vertebrates was believed to mostly rely on highly developed vision while foraging and there are relatively few studies exploring bird response to volatile organic compounds. In response to insect herbivory, plants release volatile organic compounds to attract parasitoids and predators of the pests. To test if insectivorous birds use herbivore-induced plant volatiles (HIPV), dispensers emitting a synthetic blend of HIPV typically emitted after insect herbivory were deployed in a maize field along with imitation clay caterpillars. Significantly more imitation insects were attacked by birds when located close to dispensers releasing HIPV than close to dispenser with organic solvent only. Seven times more peck marks, an index of avian predation, were counted on caterpillars in the vicinity of the HIPV dispensers than on insects close to control dispensers. This is the first field demonstration that insectivorous birds cue on HIPV to locate prey in agricultural settings. These results support the growing evidence that foraging birds exploit volatile cues. This more accurate understanding of their behavior will be important when implementing pest management program involving insectivorous birds.

Micro-fluidic partitioning between polymeric sheets for chemical amplification and processing

DOEpatents

Anderson, Brian L.

2017-01-24

A system for fluid partitioning for chemical amplification or other chemical processing or separations of a sample, comprising a first dispenser of a first polymeric sheet, wherein the first polymeric sheet contains chambers; a second dispenser of a second polymeric sheet wherein the first dispenser and the second dispenser are positioned so that the first polymeric sheet and the second polymeric sheet become parallel; a dispenser of the fluid positioned to dispense the fluid between the first polymeric sheet and the second polymeric sheet; and a seal unit that seals the first polymeric sheet and the second polymeric sheet together thereby sealing the sample between the first polymeric sheet and the second polymeric sheet and partitioning the fluid for chemical amplification or other chemical processing or separations.

Micro-fluidic partitioning between polymeric sheets for chemical amplification and processing

DOEpatents

Anderson, Brian L.

2015-05-26

A system for fluid partitioning for chemical amplification or other chemical processing or separations of a sample, comprising a first dispenser of a first polymeric sheet, wherein the first polymeric sheet contains chambers; a second dispenser of a second polymeric sheet wherein the first dispenser and the second dispenser are positioned so that the first polymeric sheet and the second polymeric sheet become parallel; a dispenser of the fluid positioned to dispense the fluid between the first polymeric sheet and the second polymeric sheet; and a seal unit that seals the first polymeric sheet and the second polymeric sheet together thereby sealing the sample between the first polymeric sheet and the second polymeric sheet and partitioning the fluid for chemical amplification or other chemical processing or separations.

Focused ion beam-assisted technology in sub-picolitre micro-dispenser fabrication

NASA Astrophysics Data System (ADS)

Lopez, M. J.; Caballero, D.; Campo, E. M.; Perez-Castillejos, R.; Errachid, A.; Esteve, J.; Plaza, J. A.

2008-07-01

Novel medical and biological applications are driving increased interest in the fabrication of micropipette or micro-dispensers. Reduced volume samples and drug dosages are prime motivators in this effort. We have combined microfabrication technology with ion beam milling techniques to successfully produce cantilever-type polysilicon micro-dispensers with 3D enclosed microchannels. The microfabrication technology described here allows for the designing of nozzles with multiple shapes. The contribution of ion beam milling has had a large impact on the fabrication process and on further customizing shapes of nozzles and inlet ports. Functionalization tests were conducted to prove the viability of ion beam-fabricated micro-dispensers. Self-assembled monolayers were successfully formed when a gold surface was patterned with a thiol solution dispensed by the fabricated micro-dispensers.

Apparatus for Sampling Surface Contamination

NASA Technical Reports Server (NTRS)

Wells, Mark

2008-01-01

An apparatus denoted a swab device has been developed as a convenient means of acquiring samples of contaminants from surfaces and suspending the samples in liquids. (Thereafter, the liquids can be dispensed, in controlled volumes, into scientific instruments for analysis of the contaminants.) The swab device is designed so as not to introduce additional contamination and to facilitate, simplify, and systematize the dispensing of controlled volumes of liquid into analytical instruments. The swab device is a single apparatus into which are combined all the equipment and materials needed for sampling surface contamination. The swab device contains disposable components stacked together on a nondisposable dispensing head. One of the disposable components is a supply cartridge holding a sufficient volume of liquid for one complete set of samples. (The liquid could be clean water or another suitable solvent, depending on the application.) This supply of liquid is sealed by Luer valves. At the beginning of a sampling process, the user tears open a sealed bag containing the supply cartridge. A tip on the nondisposable dispensing head is engaged with a Luer valve on one end of the supply cartridge and rotated, locking the supply cartridge on the dispensing head and opening the valve. The swab tip includes a fabric swab that is wiped across the surface of interest to acquire a sample. A sealed bag containing a disposable dispensing tip is then opened, and the swab tip is pushed into the dispensing tip until seated. The dispensing head contains a piston that passes through a spring-loaded lip seal. The air volume displaced by this piston forces the liquid out of the supply cartridge, over the swab, and into the dispensing tip. The piston is manually cycled to enforce oscillation of the air volume and thereby to cause water to flow to wash contaminants from the swab and cause the resulting liquid suspension of contaminants to flow into the dispensing tip. After several cycles to ensure adequate mixing, liquid containing the suspended contaminant sample is dispensed. The disposable components are then removed from the dispensing head, which may then be reused with a fresh set of disposable components.

A Review of the Anthropometric Characteristics, Grading and Dispensation of Junior and Youth Rugby Union Players in Australia.

PubMed

Patton, Declan Alexander; McIntosh, Andrew Stuart; Denny, Greg

2016-08-01

The grading of Australian junior and youth rugby union players has received substantial media attention in recent years. Media reports have focussed on size mismatches observed between players, especially players with Polynesian heritage, and the concerned parents who fear for the safety of their child owing to perceived mismatches. Although such concerns are well meaning, few media reports recognise the need for substantial evidence to determine the best grading system for junior and youth rugby union players. The current study reviewed relevant literature pertinent to the grading and dispensation of junior and youth rugby union players. Using primary and secondary search strategies, a total of 33 articles reporting the anthropometric characteristics of junior and youth rugby players were identified. Anthropometric data from the literature were compared with normative population data and currently used dispensation criteria. Junior and youth rugby players were found to be taller and heavier than normative population data. Current dispensation criteria, in terms of body mass, were found to vary and it is suggested that criteria be revised and standardised across rugby unions throughout Australia. Although it is acknowledged that other factors are important for grading players, anthropometric characteristics should be considered as potential dispensation criteria to supplement current age-based grading for junior and youth rugby union players. Measuring the body mass and stature of each junior player upon pre-season registration is suggested, which would provide data to establish valid dispensation criteria for the following season.

An evaluation of early medication use for COPD: a population-based cohort study.

PubMed

Falk, Jamie; Dik, Natalia; Bugden, Shawn

2016-01-01

The aim of this study was to evaluate the first initiation, sequence of addition, and appropriate prescribing of COPD medications in Manitoba, Canada. A population-based cohort study of COPD medication use was conducted using administrative health care data (1997-2012). Those aged ≥35 years with COPD based on three or more COPD-related outpatient visits over a rolling 24-month window or at least one COPD-related hospitalization were included. The first medication(s) dispensed on or after the date of COPD diagnosis were determined based on pharmacy claims. The next medication(s) in sequence were determined to be additions or switches to the previous regimen. Evaluation of guideline-based appropriateness to receive inhaled corticosteroids (ICS) was based on exacerbation history and past medication use. Of 13,369 patients dispensed COPD medications after diagnosis, 66.0% were dispensed short-acting bronchodilators as first medications. Although long-acting bronchodilators alone were uncommonly used as first or subsequent medications, ICS were dispensed as first medications in 28.2% of patients. Over the study period, use of short-acting bronchodilators as first medications declined from 70.6% to 59.4% ( P <0.0001), whereas the use of ICS as a first medication increased from 23.5% to 34.4% ( P <0.0001). Dispensation of an ICS plus a long-acting β-agonist increased dramatically from 1.2% to 27.3% ( P <0.0001). By the end of the study period, the majority of patients (53.3%) were being initiated on two or more medications. Of 5,823 patients dispensed an ICS, 52.4% met Canadian guideline criteria for initiating an ICS, whereas 0.3% met Global Initiative for Chronic Obstructive Lung Disease guideline criteria. The use of first-line medications has declined over time, replaced primarily by combination inhalers prescribed early without prior trials of appropriate next step medications. This, along with an increasingly predominant use of multiple first medications, indicates a significant degree of medication burden in this already complex patient population.

Food-specific sublingual immunotherapy is well tolerated and safe in healthy dogs: a blind, randomized, placebo-controlled study.

PubMed

Maina, E; Pelst, M; Hesta, M; Cox, E

2017-01-18

Food allergies are increasing in prevalence but no treatment strategies are currently available to cure dogs with food allergy. Over the past decade, experimental food allergen-specific sublingual immunotherapy (FA-SLIT) has emerged as a potential treatment for food allergies in human medicine. However, FA-SLIT has not been investigated in dogs. Therefore, the objective of this study was to prospectively evaluate the safety, tolerability and dispenser sterility of FA-SLIT in healthy dogs before testing it in food allergic dogs. Eight experimental healthy beagle dogs, never orally exposed to peanut, were randomized in two groups to receive SLIT with peanut or placebo for 4 months. Subjects were monitored daily for local and systemic adverse effects. Blood samples for complete blood count and serum biochemistry, and urine for urinalysis were collected and the dogs' body weight was recorded at day 0, 35 and 119 of the SLIT treatment. Sera for the determination of peanut-specific IgG and IgE were collected at day 0, 35, 49, 70, 91, 105 and 119. Intradermal tests were performed before (day 0) and after (day 119) the experiment. The content of each dispenser used to administer treatment or placebo was tested for sterility after usage. In order to assess the presence or absence of sensitization, dogs were challenged 6 months after the end of the study with 2000 μg of peanut extract daily for 7 to 14 days. All dogs completed the study. The treatment did not provoke either local or systemic side-effects. Peanut-specific IgG significantly increased in treatment group. Even though a significant increase in peanut-specific IgE was also seen, intradermal tests were negative in all dogs before and after the experiment, and the challenge test did not trigger any adverse reactions in the treated dogs, which shows the protocol did not cause sensitization to peanut, but nevertheless primed the immune system as indicated by the humoral immune response. All dispenser solutions were sterile. Our results demonstrate that the used peanut-SLIT protocol is well tolerated and safe in healthy dogs. Further studies should evaluate tolerability, safety and efficacy in dogs with food allergy.

21 CFR 872.3080 - Mercury and alloy dispenser.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3080 Mercury and alloy dispenser. (a... dispense into a mixing capsule a predetermined amount of dental mercury in droplet form and a premeasured...

Herpes zoster vaccine (HZV): utilization and coverage 2009 - 2013, Alberta, Canada.

PubMed

Liu, Xianfang C; Simmonds, Kimberley A; Russell, Margaret L; Svenson, Lawrence W

2014-10-23

Herpes zoster vaccine (HZV) is not publicly funded in the province of Alberta, Canada. We estimated vaccine coverage among those aged 60 years or older for 2013, as well as vaccine utilization rates per hundred thousand population over the period 2009 - 2013. We explored for factors associated with HZV dispensing rates. We used administrative data from the Alberta Pharmaceutical Information Network (PIN) database to identify unique persons for whom HZV had been dispensed from community pharmacies over 2009 - 2013. PIN data were also used to estimate the pharmacy/population ratios for rural and urban Alberta over the period. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Plan Registry. Income quintile data were estimated from the 2006 Census of Canada. Crude, age, sex, geographic (rural vs. urban), income-quintile and year specific rates of HZV vaccine dispensing were estimated per 100,000 population. Rates were adjusted for pharmacy/population ratio. Vaccine coverage for persons aged 60 years or older was estimated using counts of all unique persons for whom the vaccine was dispensed over the period in the numerator and a 2013 mid- year population denominator. HZV dispensing rates rose annually from 2009 - 2013. Vaccine coverage was estimated to be 8.4% among persons aged 60 years or older. Rates of dispensing were highest for persons aged 60-69 years and were higher for females than males and for persons from higher compared to lower income quintiles. Dispensing rates were lower for rural than for urban residents. About 2% of vaccine was dispensed for persons aged less than 50 years. Rates of HZV dispensing are increasing rapidly in Alberta despite a lack of public funding. A small proportion of the vaccine may be dispensed off-label.

14 CFR 137.3 - Definition of terms.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the operation of an aircraft for the purpose of (1) dispensing any economic poison, (2) dispensing any... preservation, but not including the dispensing of live insects. Economic poison means (1) any substance or...

14 CFR 137.3 - Definition of terms.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the operation of an aircraft for the purpose of (1) dispensing any economic poison, (2) dispensing any... preservation, but not including the dispensing of live insects. Economic poison means (1) any substance or...

14 CFR 137.3 - Definition of terms.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the operation of an aircraft for the purpose of (1) dispensing any economic poison, (2) dispensing any... preservation, but not including the dispensing of live insects. Economic poison means (1) any substance or...

14 CFR 137.3 - Definition of terms.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the operation of an aircraft for the purpose of (1) dispensing any economic poison, (2) dispensing any... preservation, but not including the dispensing of live insects. Economic poison means (1) any substance or...

Poorly processed reusable surface disinfection tissue dispensers may be a source of infection.

PubMed

Kampf, Günter; Degenhardt, Stina; Lackner, Sibylle; Jesse, Katrin; von Baum, Heike; Ostermeyer, Christiane

2014-01-21

Reusable surface disinfectant tissue dispensers are used in hospitals in many countries because they allow immediate access to pre-soaked tissues for targeted surface decontamination. On the other hand disinfectant solutions with some active ingredients may get contaminated and cause outbreaks. We determined the frequency of contaminated surface disinfectant solutions in reusable dispensers and the ability of isolates to multiply in different formulations. Reusable tissue dispensers with different surface disinfectants were randomly collected from healthcare facilities. Solutions were investigated for bacterial contamination. The efficacy of two surface disinfectants was determined in suspension tests against two isolated species directly from a contaminated solution or after 5 passages without selection pressure in triplicate. Freshly prepared use solutions were contaminated to determine survival of isolates. 66 dispensers containing disinfectant solutions with surface-active ingredients were collected in 15 healthcare facilities. 28 dispensers from nine healthcare facilities were contaminated with approximately 107 cells per mL of Achromobacter species 3 (9 hospitals), Achromobacter xylosoxidans or Serratia marcescens (1 hospital each). In none of the hospitals dispenser processing had been adequately performed. Isolates regained susceptibility to the disinfectants after five passages without selection pressure but were still able to multiply in different formulations from different manufacturers at room temperature within 7 days. Neglecting adequate processing of surface disinfectant dispensers has contributed to frequent and heavy contamination of use-solutions based on surface active ingredients. Tissue dispenser processing should be taken seriously in clinical practice.

Poorly processed reusable surface disinfection tissue dispensers may be a source of infection

PubMed Central

2014-01-01

Background Reusable surface disinfectant tissue dispensers are used in hospitals in many countries because they allow immediate access to pre-soaked tissues for targeted surface decontamination. On the other hand disinfectant solutions with some active ingredients may get contaminated and cause outbreaks. We determined the frequency of contaminated surface disinfectant solutions in reusable dispensers and the ability of isolates to multiply in different formulations. Methods Reusable tissue dispensers with different surface disinfectants were randomly collected from healthcare facilities. Solutions were investigated for bacterial contamination. The efficacy of two surface disinfectants was determined in suspension tests against two isolated species directly from a contaminated solution or after 5 passages without selection pressure in triplicate. Freshly prepared use solutions were contaminated to determine survival of isolates. Results 66 dispensers containing disinfectant solutions with surface-active ingredients were collected in 15 healthcare facilities. 28 dispensers from nine healthcare facilities were contaminated with approximately 107 cells per mL of Achromobacter species 3 (9 hospitals), Achromobacter xylosoxidans or Serratia marcescens (1 hospital each). In none of the hospitals dispenser processing had been adequately performed. Isolates regained susceptibility to the disinfectants after five passages without selection pressure but were still able to multiply in different formulations from different manufacturers at room temperature within 7 days. Conclusions Neglecting adequate processing of surface disinfectant dispensers has contributed to frequent and heavy contamination of use-solutions based on surface active ingredients. Tissue dispenser processing should be taken seriously in clinical practice. PMID:24447780

Picoliter Drop-On-Demand Dispensing for Multiplex Liquid Cell Transmission Electron Microscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Patterson, Joseph P.; Parent, Lucas R.; Cantlon, Joshua

2016-05-03

Abstract Liquid cell transmission electron microscopy (LCTEM) provides a unique insight into the dynamics of nanomaterials in solution. Controlling the addition of multiple solutions to the liquid cell remains a key hurdle in our ability to increase throughput and to study processes dependent on solution mixing including chemical reactions. Here, we report that a piezo dispensing technique allows for mixing of multiple solutions directly within the viewing area. This technique permits deposition of 50 pL droplets of various aqueous solutions onto the liquid cell window, before assembly of the cell in a fully controlled manner. This proof-of-concept study highlights themore » great potential of picoliter dispensing in combination with LCTEM for observing nanoparticle mixing in the solution phase and the creation of chemical gradients.« less

Workload in community pharmacies in the UK and its impact on patient safety and pharmacists' well-being: a review of the evidence.

PubMed

Hassell, Karen; Seston, Elizabeth Mary; Schafheutle, Ellen Ingrid; Wagner, Andrew; Eden, Martin

2011-11-01

New contractual frameworks for community pharmacy are believed to have increased workload for pharmacists; too much work has been implicated in high profile cases of dispensing errors leading to patient harm, and concerns about pharmacists' well-being. A review was undertaken to ascertain whether community pharmacists' workload has increased and whether links between workload and patient safety and pharmacists' well-being have been established. We searched Scopus; EMBASE; MEDLINE; PubMed; CINAHL; PsychINFO; ASSIA; E-pic, and International Pharmaceutical Abstracts for research published between 1989 and 2010 containing data on UK community pharmacy workload, and on its consequences when workload was found to be a determinant of either patient or pharmacist outcomes. Researchers assessed retrieved material against inclusion and exclusion criteria and synthesised findings using a data extraction form. Fifteen studies were retrieved that met the inclusion criteria. A number of methodological weaknesses were identified: studies categorised work tasks and workload differently making comparisons over time or between studies difficult; most studies were small scale or conducted in specific localities, or lacked sufficient methodological information to rule out bias; studies that control for possible confounders are rare. The reviewed research suggests that community pharmacists still spend the majority of their time involved in activities associated with the dispensing of prescriptions. There is some evidence that community pharmacists' workload has increased since the introduction of the new contracts in England and Wales, especially around the core activity of dispensing prescriptions and medicines use reviews. There is also some evidence to suggest a link between heavy workload and aspects of pharmacists' well-being but there is no robust evidence indicating threats to patient safety caused by their having too much work to do. More high quality research is required to examine what constitutes too much work, the impact of high workload, and associations with other work place factors. © 2011 Blackwell Publishing Ltd.

Deterministic bead-in-droplet ejection utilizing an integrated plug-in bead dispenser for single bead-based applications

NASA Astrophysics Data System (ADS)

Kim, Hojin; Choi, In Ho; Lee, Sanghyun; Won, Dong-Joon; Oh, Yong Suk; Kwon, Donghoon; Sung, Hyung Jin; Jeon, Sangmin; Kim, Joonwon

2017-04-01

This paper presents a deterministic bead-in-droplet ejection (BIDE) technique that regulates the precise distribution of microbeads in an ejected droplet. The deterministic BIDE was realized through the effective integration of a microfluidic single-particle handling technique with a liquid dispensing system. The integrated bead dispenser facilitates the transfer of the desired number of beads into a dispensing volume and the on-demand ejection of bead-encapsulated droplets. Single bead-encapsulated droplets were ejected every 3 s without any failure. Multiple-bead dispensing with deterministic control of the number of beads was demonstrated to emphasize the originality and quality of the proposed dispensing technique. The dispenser was mounted using a plug-socket type connection, and the dispensing process was completely automated using a programmed sequence without any microscopic observation. To demonstrate a potential application of the technique, bead-based streptavidin-biotin binding assay in an evaporating droplet was conducted using ultralow numbers of beads. The results evidenced the number of beads in the droplet crucially influences the reliability of the assay. Therefore, the proposed deterministic bead-in-droplet technology can be utilized to deliver desired beads onto a reaction site, particularly to reliably and efficiently enrich and detect target biomolecules.

Deterministic bead-in-droplet ejection utilizing an integrated plug-in bead dispenser for single bead-based applications.

PubMed

Kim, Hojin; Choi, In Ho; Lee, Sanghyun; Won, Dong-Joon; Oh, Yong Suk; Kwon, Donghoon; Sung, Hyung Jin; Jeon, Sangmin; Kim, Joonwon

2017-04-10

This paper presents a deterministic bead-in-droplet ejection (BIDE) technique that regulates the precise distribution of microbeads in an ejected droplet. The deterministic BIDE was realized through the effective integration of a microfluidic single-particle handling technique with a liquid dispensing system. The integrated bead dispenser facilitates the transfer of the desired number of beads into a dispensing volume and the on-demand ejection of bead-encapsulated droplets. Single bead-encapsulated droplets were ejected every 3 s without any failure. Multiple-bead dispensing with deterministic control of the number of beads was demonstrated to emphasize the originality and quality of the proposed dispensing technique. The dispenser was mounted using a plug-socket type connection, and the dispensing process was completely automated using a programmed sequence without any microscopic observation. To demonstrate a potential application of the technique, bead-based streptavidin-biotin binding assay in an evaporating droplet was conducted using ultralow numbers of beads. The results evidenced the number of beads in the droplet crucially influences the reliability of the assay. Therefore, the proposed deterministic bead-in-droplet technology can be utilized to deliver desired beads onto a reaction site, particularly to reliably and efficiently enrich and detect target biomolecules.

Deterministic bead-in-droplet ejection utilizing an integrated plug-in bead dispenser for single bead–based applications

PubMed Central

Kim, Hojin; Choi, In Ho; Lee, Sanghyun; Won, Dong-Joon; Oh, Yong Suk; Kwon, Donghoon; Sung, Hyung Jin; Jeon, Sangmin; Kim, Joonwon

2017-01-01

This paper presents a deterministic bead-in-droplet ejection (BIDE) technique that regulates the precise distribution of microbeads in an ejected droplet. The deterministic BIDE was realized through the effective integration of a microfluidic single-particle handling technique with a liquid dispensing system. The integrated bead dispenser facilitates the transfer of the desired number of beads into a dispensing volume and the on-demand ejection of bead-encapsulated droplets. Single bead–encapsulated droplets were ejected every 3 s without any failure. Multiple-bead dispensing with deterministic control of the number of beads was demonstrated to emphasize the originality and quality of the proposed dispensing technique. The dispenser was mounted using a plug-socket type connection, and the dispensing process was completely automated using a programmed sequence without any microscopic observation. To demonstrate a potential application of the technique, bead-based streptavidin–biotin binding assay in an evaporating droplet was conducted using ultralow numbers of beads. The results evidenced the number of beads in the droplet crucially influences the reliability of the assay. Therefore, the proposed deterministic bead-in-droplet technology can be utilized to deliver desired beads onto a reaction site, particularly to reliably and efficiently enrich and detect target biomolecules. PMID:28393911

Reformulation of controlled-release oxycodone and pharmacy dispensing patterns near the US-Canada border.

PubMed

Gomes, Tara; Paterson, J Michael; Juurlink, David N; Dhalla, Irfan A; Mamdani, Muhammad M

2012-01-01

In August 2010, a tamper-resistant formulation of controlled-release oxycodone (OxyContin-OP) was introduced in the United States but not in Canada. Our objective was to determine whether introduction of OxyContin-OP in the United States influenced prescription volumes for the original controlled-release oxycodone formulation (OxyContin) at Canadian pharmacies near the international border. We conducted a population-based, serial, cross-sectional study of prescriptions dispensed from pharmacies in the 3 cities with the highest volume of US-Canada border crossings in Ontario: Niagara Falls, Windsor and Sarnia. We analyzed data on all outpatient prescriptions for OxyContin dispensed by Canadian pharmacies near each border crossing between 2010 Apr. 1 and 2012 Feb. 29. We calculated and compared monthly prescription rates, adjusted per 1000 population and stratified by tablet strength. The number of tablets dispensed near 4 border crossings in the 3 Canadian cities remained stable over the study period. However, the rate of dispensing at pharmacies near the Detroit-Windsor Tunnel increased roughly 4-fold between August 2010 and February 2011, from 505 to 1969 tablets per 1000 population. By April 2011, following warnings to prescribers and pharmacies regarding drug-seeking behaviour, the dispensing rate declined to 1683 tablets per 1000 population in this area. By November 2011, the rate had returned to levels observed in early 2010. Our analyses suggest that 242 075 excess OxyContin tablets were dispensed near the Detroit-Windsor Tunnel between August 2010 and October 2011. Prescribing of the original formulation of controlled-release oxycodone rose substantially near a major international border crossing following the introduction of a tamper-resistant formulation in the United States. It is possible that the restriction of this finding to the area surrounding the Detroit-Windsor Tunnel reflects specific characteristics of this border crossing, including its high traffic volume, direct access to the downtown core and drug-trafficking patterns in the Detroit area. Our findings highlight the potential impact of cross-border differences in medication availability on drug-seeking behaviour.

Dispensing and determinants of non-adherence to treatment for non complicated malaria caused by Plasmodium vivax and Plasmodium falciparum in high-risk municipalities in the Brazilian Amazon.

PubMed

Osorio-de-Castro, Claudia G S; Suárez-Mutis, Martha C; Miranda, Elaine S; Luz, Tatiana C B

2015-11-26

In Brazil, 99.7 % of malaria cases occur in the Amazon region. Although the number of cases is decreasing, the country accounted for almost 60 % of cases in the Americas Region, in 2013. Novel approaches for malaria treatment open the possibility of eliminating the disease, but suboptimal dispensing and lack of adherence influence treatment outcomes. The aim of this paper is to show the results on dispensing practices, non-adherence and determinants of non-adherence to treatment of non-complicated malaria. The study was conducted in six high-risk municipalities with Plasmodium vivax and Plasmodium falciparum transmission in the Brazilian Amazon and based on the theoretical framework of the Mafalda Project, which included investigation of dispensing and adherence. The World Health Organization Rapid Evaluation Method has been used to estimate sample size. Individuals over 15 years of age with malaria were approached at health facilities and invited to participate through informed consent. Data was collected in chart review forms focusing on diagnosis, Plasmodium type, prescribing, and dispensing (kind, quantity, labelling and procedures). Follow-up household interviews complemented data collection at health facility. Non-adherence was measured during the implementation phase, by self-reports and pill-counts. Analysis was descriptive and statistical tests were carried out. Determinants of non-adherence and quality of dispensing were assessed according to the literature. The study involved 165 patients. Dispensing was done according to the national guidelines. Labelling was adequate for P. vivax but inadequate for P. falciparum medicines. Non-adherent patients were 12.1 % according to self-reports and 21.8 % according to pill-counts. Results point to greater non-adherence among all P. falciparum patients and among malaria non-naîve patients. More patients informed understanding adverse effects than 'how to use' anti-malarials. Non-adherent patients were mostly those with a P. falciparum diagnosis and those in their second or more malaria episode. New taxonomies and concepts on adherence stress the importance of focusing on the individual patient. Interventions targeted to and tailored for malaria patients must be addressed by health policy and implemented by managers and clinicians.

Method and system for aligning fibers during electrospinning

NASA Technical Reports Server (NTRS)

Scott-Carnell, Lisa A. (Inventor); Stephens, Ralph M (Inventor); Holloway, Nancy M. (Inventor); Rhim, Caroline (Inventor); Niklason, Laura (Inventor); Clark, Robert L. (Inventor); Siochi, Emilie J. (Inventor)

2011-01-01

A method and system are provided for aligning fibers in an electrospinning process. A jet of a fiberizable material is directed towards an uncharged collector from a dispensing location that is spaced apart from the collector. While the fiberizable material is directed towards the collector, an elliptical electric field is generated via the electrically charged dispenser and an oppositely-charged control location. The field spans between the dispensing location and the control location that is within line-of-sight of the dispensing location, and impinges upon at least a portion of the collector. Various combinations of numbers and geometries of dispensers, collectors, and electrodes can be used.

Dispenser printed electroluminescent lamps on textiles for smart fabric applications

NASA Astrophysics Data System (ADS)

de Vos, Marc; Torah, Russel; Tudor, John

2016-04-01

Flexible electroluminescent (EL) lamps are fabricated onto woven textiles using a novel dispenser printing process. Dispenser printing utilizes pressurized air to deposit ink onto a substrate through a syringe and nozzle. This work demonstrates the first use of this technology to fabricate EL lamps. The luminance of the dispenser printed EL lamps is compared to screen-printed EL lamps, both printed on textile, and also commercial EL lamps on polyurethane film. The dispenser printed lamps are shown to have a 1.5 times higher luminance than the best performing commercially available lamp, and have a comparable performance to the screen-printed lamps.

21 CFR 1304.22 - Records for manufacturers, distributors, dispensers, researchers, importers and exporters.

Code of Federal Regulations, 2010 CFR

2010-04-01

... other controlled or noncontrolled substances in finished form, (i) The name of the substance; (ii) The... manufactured; (E) The quantity used in quality control; (F) The quantity lost during manufacturing and the... controlled substances used in the manufacturing process; (vi) The quantity used to manufacture other...

The Japanese Copula: A Dummy?

ERIC Educational Resources Information Center

Wenck, G.

1973-01-01

Discussion of whether the Japanese copula can adequately be described as a dummy, i.e., as an element which although existing in the surface structure can be dispensed with in the deep structure of a sentence; based on a paper read at the 1970 meeting of the Societas Linguistica Europaea, Prague, Czechoslovakia. (RS)

The association of subjective workload dimensions on quality of care and pharmacist quality of work life.

PubMed

Chui, Michelle A; Look, Kevin A; Mott, David A

2014-01-01

Workload has been described both objectively (e.g., number of prescriptions dispensed per pharmacist) as well as subjectively (e.g., pharmacist's perception of busyness). These approaches might be missing important characteristics of pharmacist workload that have not been previously identified and measured. To measure the association of community pharmacists' workload perceptions at three levels (organization, job, and task) with job satisfaction, burnout, and perceived performance of two tasks in the medication dispensing process. A secondary data analysis was performed using cross-sectional survey data collected from Wisconsin (US) community pharmacists. Organization-related workload was measured as staffing adequacy; job-related workload was measured as general and specific job demands; task-related workload was measured as internal and external mental demands. Pharmacists' perceived task performance was assessed for patient profile review and patient consultation. The survey was administered to a random sample of 500 pharmacists who were asked to opt in if they were a community pharmacist. Descriptive statistics and correlations of study variables were determined. Two structural equation models were estimated to examine relationships between the study variables and perceived task performance. From the 224 eligible community pharmacists that agreed to participate, 165 (73.7%) usable surveys were completed and returned. Job satisfaction and job-related monitoring demands had direct positive associations with both dispensing tasks. External task demands were negatively related to perceived patient consultation performance. Indirect effects on both tasks were primarily mediated through job satisfaction, which was positively related to staffing adequacy and cognitive job demands and negatively related to volume job demands. External task demands had an additional indirect effect on perceived patient consultation performance, as it was associated with lower levels of job satisfaction and higher levels of burnout. Allowing community pharmacists to concentrate on tasks and limiting interruptions while performing these tasks are important factors in improving quality of patient care and pharmacist work life. The results have implications for strategies to improve patient safety and pharmacist performance. Copyright © 2014 Elsevier Inc. All rights reserved.

The Association of Subjective Workload Dimensions on Quality of Care and Pharmacist Quality of Work Life

PubMed Central

Chui, Michelle A.; Look, Kevin A.; Mott, David A.

2013-01-01

Background Workload has been described both objectively (e.g., number of prescriptions dispensed per pharmacist) as well as subjectively (e.g., pharmacist’s perception of busyness). These approaches might be missing important characteristics of pharmacist workload that have not been previously identified and measured. Objectives To measure the association of community pharmacists’ workload perceptions at three levels (organization, job, and task) with job satisfaction, burnout, and perceived performance of two tasks in the medication dispensing process. Methods A secondary data analysis was performed using cross-sectional survey data collected from Wisconsin (US) community pharmacists. Organization–related workload was measured as staffing adequacy; job-related workload was measured as general and specific job demands; task-related workload was measured as internal and external mental demands. Pharmacists’ perceived task performance was assessed for patient profile review and patient consultation. The survey was administered to a random sample of 500 pharmacists who were asked to opt in if they were a community pharmacist. Descriptive statistics and correlations of study variables were determined. Two structural equation models were estimated to examine relationships between the study variables and perceived task performance. Results From the 224 eligible community pharmacists that agreed to participate, 165 (73.7%) usable surveys were completed and returned. Job satisfaction and job-related monitoring demands had direct positive associations with both dispensing tasks. External task demands were negatively related to perceived patient consultation performance. Indirect effects on both tasks were primarily mediated through job satisfaction, which was positively related to staffing adequacy and cognitive job demands and negatively related to volume job demands. External task demands had an additional indirect effect on perceived patient consultation performance, as it was associated with lower levels of job satisfaction and higher levels of burnout. Implications/Conclusions Allowing community pharmacists to concentrate on tasks and limiting interruptions while performing these tasks are important factors in improving quality of patient care and pharmacist work life. The results have implications for strategies to improve patient safety and pharmacist performance. PMID:23791360

Behnken during EVA 4 - Expedition 16 / STS-13 Joint Operations

NASA Image and Video Library

2008-03-21

S123-E-007816 (21 March 2008) --- Astronaut Robert L. Behnken, STS-123 mission specialist, participates in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Behnken and astronaut Mike Foreman (out of frame), mission specialist, replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Foreman during Expedition 16 / STS-123 EVA 4

NASA Image and Video Library

2008-03-21

ISS016-E-033394 (21 March 2008) --- Astronaut Mike Foreman, STS-123 mission specialist, participates in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Foreman and astronaut Robert L. Behnken (out of frame), mission specialist, replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Foreman during EVA 4 - Expedition 16 / STS-13 Joint Operations

NASA Image and Video Library

2008-03-21

S123-E-007832 (21 March 2008) --- Astronaut Mike Foreman, STS-123 mission specialist, participates in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Foreman and astronaut Robert L. Behnken (out of frame), mission specialist, replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Behnken during EVA 4 - Expedition 16 / STS-13 Joint Operations

NASA Image and Video Library

2008-03-21

S123-E-007907 (21 March 2008) --- Astronaut Robert L. Behnken, STS-123 mission specialist, participates in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Behnken and astronaut Mike Foreman (out of frame), mission specialist, replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Behnken and Foreman during EVA 4 - Expedition 16 / STS-13 Joint Operations

NASA Image and Video Library

2008-03-21

S123-E-007838 (21 March 2008) --- Astronauts Robert L. Behnken (top) and Mike Foreman, both STS-123 mission specialists, participate in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Behnken and Foreman replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Behnken during EVA 4 - Expedition 16 / STS-13 Joint Operations

NASA Image and Video Library

2008-03-21

S123-E-007906 (21 March 2008) --- Astronaut Robert L. Behnken, STS-123 mission specialist, participates in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Behnken and astronaut Mike Foreman (out of frame), mission specialist, replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Behnken during EVA 4 - Expedition 16 / STS-13 Joint Operations

NASA Image and Video Library

2008-03-21

S123-E-007909 (21 March 2008) --- Astronaut Robert L. Behnken, STS-123 mission specialist, participates in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Behnken and astronaut Mike Foreman (out of frame), mission specialist, replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Behnken and Foreman during EVA 4 - Expedition 16 / STS-13 Joint Operations

NASA Image and Video Library

2008-03-21

S123-E-007839 (21 March 2008) --- Astronauts Mike Foreman (foreground) and Robert L. Behnken, both STS-123 mission specialists, participate in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Foreman and Behnken replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground.

Activation function 2 (AF2) of estrogen receptor-α is required for the atheroprotective action of estradiol but not to accelerate endothelial healing

PubMed Central

Billon-Galés, Audrey; Krust, Andrée; Fontaine, Coralie; Abot, Anne; Flouriot, Gilles; Toutain, Céline; Berges, Hortense; Gadeau, Alain-Pierre; Lenfant, Françoise; Gourdy, Pierre; Chambon, Pierre; Arnal, Jean-François

2011-01-01

17β-Estradiol (E2) regulates estrogen receptor-α (ERα) target gene transcription through the two independent activation functions (AFs), AF1 and AF2, located in the N-terminal and ligand binding domain of ERα, respectively. We previously reported that ERα is required for the E2 atheroprotective action as well as for its accelerative action on endothelial healing, but its AF1 function is dispensable. Here, we investigated the role of ERαAF2 in these two major beneficial actions of E2 by electively targeting ERαAF2 (named ERαAF20). Our results prove four points. (i) Compared with WT ERα, the ability of ERαAF20 to stimulate the C3 complement or the estrogen response element-thymidine kinase promoter in two cell lines was dramatically decreased, confirming the importance of AF2 in the E2-induced transcriptional activity of ERα. (ii) The uterotrophic action of E2 was totally absent in ERαAF20 mice, showing the crucial role of ERαAF2 in E2-induced uterus hyperplasia. (iii) ERαAF2 was dispensable for the accelerative action of E2 on endothelial healing, underlining the functionality of ERαAF20 in vivo. (iv) Finally, the atheroprotective effect of E2 was abrogated in ERαAF20 LDL-r−/− mice. Thus, whereas ERαAF1 and ERαAF2 are both required for the uterotrophic action of E2, we show that only ERαAF2 is necessary for its atheroprotective effect. PMID:21788522

30 CFR 75.1905 - Dispensing of diesel fuel.

Code of Federal Regulations, 2012 CFR

2012-07-01

... from other than safety cans must be dispensed by means of— (1) Gravity feed with a hose equipped with a...) An anti-siphoning device. (c) Diesel fuel must not be dispensed using compressed gas. (d) Diesel fuel...

30 CFR 75.1905 - Dispensing of diesel fuel.

Code of Federal Regulations, 2013 CFR

2013-07-01

... from other than safety cans must be dispensed by means of— (1) Gravity feed with a hose equipped with a...) An anti-siphoning device. (c) Diesel fuel must not be dispensed using compressed gas. (d) Diesel fuel...

30 CFR 75.1905 - Dispensing of diesel fuel.

Code of Federal Regulations, 2014 CFR

2014-07-01

... from other than safety cans must be dispensed by means of— (1) Gravity feed with a hose equipped with a...) An anti-siphoning device. (c) Diesel fuel must not be dispensed using compressed gas. (d) Diesel fuel...

Who dispenses pharmaceuticals to children at school?

PubMed

Francis, E E; Hemmat, J P; Treloar, D M; Yarandi, H

1996-12-01

Use of both prescription and non-prescription pharmaceuticals has increased among children. Many of these drugs are taken during school hours and dispensed by school personnel who are not health professionals. They know little or nothing about the drugs themselves or the medical conditions requiring their use. This survey examined the extent to which pharmaceuticals are dispensed in schools in one Florida county. Public elementary, middle, and high schools and six private schools were surveyed for one week. All medications dispensed by school personnel during that time were recorded. Of 28,134 children surveyed, 1,016 children received 5,411 doses of medication. Thirty-one categories of drugs were dispensed including controlled substances. Methylphenidate was the most widely dispensed drug, comprising about half of all the medications given in school. Medication use was evaluated in terms of gender, race, and socioeconomic status of the children.

Automation of Vapor-Diffusion Growth of Protein Crystals

NASA Technical Reports Server (NTRS)

Hamrick, David T.; Bray, Terry L.

2005-01-01

Some improvements have been made in a system of laboratory equipment developed previously for studying the crystallization of proteins from solution by use of dynamically controlled flows of dry gas. The improvements involve mainly (1) automation of dispensing of liquids for starting experiments, (2) automatic control of drying of protein solutions during the experiments, and (3) provision for automated acquisition of video images for monitoring experiments in progress and for post-experiment analysis. The automation of dispensing of liquids was effected by adding an automated liquid-handling robot that can aspirate source solutions and dispense them in either a hanging-drop or a sitting-drop configuration, whichever is specified, in each of 48 experiment chambers. A video camera of approximately the size and shape of a lipstick dispenser was added to a mobile stage that is part of the robot, in order to enable automated acquisition of images in each experiment chamber. The experiment chambers were redesigned to enable the use of sitting drops, enable backlighting of each specimen, and facilitate automation.

Diastolic timed Vibro-Percussion at 50 Hz delivered across a chest wall sized meat barrier enhances clot dissolution and remotely administered Streptokinase effectiveness in an in-vitro model of acute coronary thrombosis

PubMed Central

2012-01-01

Background Low Frequency Vibro-Percussion (LFVP) assists clearance of thrombi in catheter systems and when applied to the heart and timed to diastole is known to enhance coronary flow. However LFVP on a clotted coronary like vessel given engagement over a chest wall sized barrier (to resemble non-invasive heart attack therapy) requires study. Methods One hour old clots (n=16) were dispensed within a flexible segment of Soft-Flo catheter (4 mm lumen), weighted, interfaced with Heparinized Saline (HS), secured atop a curved dampening base, and photographed. A ~4 cm meat slab was placed over the segment and randomized to receive intermittent LFVP (engaged, - disengaged at 1 second intervals), or no LFVP for 20 minutes. HS was pulsed (~120/80 mmHg), with the diastolic phase coordinated to match LFVP delivery. The segment was then re-photographed and aspirated of fluid to determine post clot weight. The trial was then repeated with 0.5 mls of Streptokinase (15,000 IU/100 microlitre) delivered ~ 2 cm upstream from the clot. Results LFVP - HS only samples (vs. controls) showed; a) development of clot length fluid channels absent in the control group (p < 0.0002); b) enhanced dissolved clot mixing scores ( 5.0 vs. 0.8, p < 2.8 E – 6); and c) increased percent clot dissolution (23.0% vs. 1.8% respectively, p < 8.5 E-6). LFVP - SK samples had a similar comparative clot disruptive profile, however fluid channels developed faster and percent clot dissolution more than doubled (51.0% vs. 3.0%, p< 9.8 E- 6). Conclusion Diastolic timed LFVP (50 Hz) engaged across a chest wall sized barrier enhances clot disruptive effects to an underlying coronary like system. PMID:23146079

Efficacy of a Feed Dispenser for Horses in Decreasing Cribbing Behaviour

PubMed Central

Palestrini, Clara; Cannas, Simona; Fè, Eleonora; Bagnato, Gaia Lisa; Vigo, Daniele; Frank, Diane; Minero, Michela

2016-01-01

Cribbing is an oral stereotypy, tends to develop in captive animals as a means to cope with stress, and may be indicative of reduced welfare. Highly energetic diets ingested in a short time are one of the most relevant risk factors for the development of cribbing. The aim of this study was to verify whether feeding cribbing horses through a dispenser that delivers small quantities of concentrate when activated by the animal decreases cribbing behaviour, modifies feeding behaviour, or induces frustration. Ten horses (mean age 14 y), balanced for sex, breed, and size (mean height 162 cm), were divided into two groups of 5 horses each: Cribbing and Control. Animals were trained to use the dispenser and videorecorded continuously for 15 consecutive days from 1 h prior to feeding to 2 h after feeding in order to measure their behaviours. The feed dispenser, Quaryka®, induced an increase in time necessary to finish the ration in both groups of horses (P < 0.05). With Quaryka, cribbers showed a significant reduction of time spent cribbing (P < 0.05). After removal of the feed dispenser (Post-Quaryka), cribbing behaviour significantly increased. The use of Quaryka may be particularly beneficial in horses fed high-energy diets and ingesting the food too quickly. PMID:27818832

Cell division is dispensable but not irrelevant in Streptomyces.

PubMed

McCormick, Joseph R

2009-12-01

In part, members of the genus Streptomyces have been studied because they produce many important secondary metabolites with antibiotic activity and for the interest in their relatively elaborate life cycle. These sporulating filamentous bacteria are remarkably synchronous for division and genome segregation in specialized aerial hyphae. Streptomycetes share some, but not all, of the division genes identified in the historic model rod-shaped organisms. Curiously, normally essential cell division genes are dispensable for growth and viability of Streptomyces coelicolor. Mainly, cell division plays a more important role in the developmental phase of life than during vegetative growth. Dispensability provides an advantageous genetic system to probe the mechanisms of division proteins, especially those with functions that are poorly understood.

Appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria.

PubMed

Saengcharoen, Woranuch; Jaisawang, Pornchanok; Udomcharoensab, Palita; Buathong, Kittika; Lerkiatbundit, Sanguan

2016-10-01

Background Inappropriate use of antibiotic treatment for pharyngitis by community pharmacists is prevalent in developing countries. Little is known about how the pharmacists identify patients with bacterial pharyngitis. Objective To ascertain the appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria and to identify factors related to antibiotic dispensing. Setting 1040 Thai community pharmacists. Method A cross-sectional survey of community pharmacists was conducted in November 2012 to March 2013. The self-administered questionnaires were mailed to 57 % of community pharmacists in the south of Thailand (n = 1040). The survey included questions on diagnosis of streptococcal pharyngitis, knowledge on pharyngitis, and attitudes and control beliefs regarding antibiotic dispensing. Main outcome measure The appropriateness of diagnosis of streptococcal pharyngitis according to the original and modified Centor criteria and determinants of antibiotic dispensing including demographic characteristics of pharmacists, knowledge on pharyngitis, and attitudes and control beliefs on antibiotic dispensing. Results Approximately 68 % completed the questionnaires (n = 703). Compared to the pharmacists who reported not dispensing antibiotics in the hypothetical case with common cold, those reported dispensing antibiotics were more likely to consider the following conditions-presence of cough, mild sore throat and patients with age >60 years as cues for diagnosis of streptococcal pharyngitis (p < 0.05). The use of fewer scores of the clinical prediction rules for diagnosis was observed in antibiotic dispensers, compared to who did not do so (p < 0.005). Antibiotic dispensing was positively associated with period of dispensing experience (>5 years) [odds ratio (OR) 1.52; 95 % confidence interval (CI) 1.03-2.23], belief that antibiotics could shorten duration of pharyngitis (OR 1.48; 95 % CI 1.11-1.99), belief that antibiotics could prevent the complications (OR 1.44; 95 % CI 1.09-1.91) and belief that dispensing antibiotics could satisfy the patients (OR 1.31; 95 % CI 1.01-1.71). Nonetheless, antibiotic dispensing was negatively associated with knowledge about pharyngitis (OR 0.83; 95 % CI 0.75-0.93). Conclusion Pharmacists who are knowledgeable on the Centor criteria are more likely to appropriately diagnose streptococcal pharyngitis and less likely to dispense antibiotics in such case.

Hand sanitizer dispensers and associated hospital-acquired infections: friend or fomite?

PubMed

Eiref, Simon D; Leitman, I Michael; Riley, William

2012-06-01

Waterless alcohol-based hand sanitizers are an increasingly popular method of hand hygiene and help prevent hospital-acquired infection (HAI). Whether hand sanitizer dispensers (HSDs) may themselves harbor pathogens or act as fomites has not been reported. All HSDs in the surgical intensive care unit of an urban teaching hospital were cultured at three sites: The dispenser lever, the rear underside, and the area surrounding the dispensing nozzle. All HSDs yielded one or more bacterial species, including commensal skin flora and enteric gram-negative bacilli. Colonization was greatest on the lever, where there is direct hand contact. Hand sanitizer dispensers can become contaminated with pathogens that cause HAI and thus are potential fomites.

The plume also rises: trajectories of pheromone plumes issuing from point sources in an orchard canopy at night.

PubMed

Girling, Robbie D; Higbee, Bradley S; Cardé, Ring T

2013-09-01

The trajectories of pheromone plumes in canopied habitats, such as orchards, have been little studied. We documented the capture of male navel orangeworm moths, Amyelois transitella, in female-baited traps positioned at 5 levels, from ground level to the canopy top, at approximately 6 m above ground, in almond orchards. Males were captured in similar proportions at all levels, suggesting that they do not favor a particular height during ranging flight. A 3-D sonic anemometer was used to establish patterns of wind flow and temperature at 6 heights from 2.08 to 6.65 m in an almond orchard with a 5 m high canopy, every 3 h over 72 h. The horizontal velocity of wind flow was highest above the canopy, where its directionality also was the most consistent. During the time of A. transitella mating (0300-0600), there was a net vertical displacement upward. Vertical buoyancy combined with only minor reductions in the distance that plumes will travel in the lower compared to the upper canopy suggest that the optimal height for release of pheromone from high-release rate sources, such as aerosol dispensers (“puffers”), that are deployed at low densities (e.g., 3 per ha.) would be at mid or low in the canopy, thereby facilitating dispersion of disruptant throughout the canopy. Optimal placement of aerosol dispensers will vary with the behavioral ecology of the target pest; however, our results suggest that current protocols, which generally propose dispenser placement in the upper third of the canopy, should be reevaluated.

Global Analysis of the Sporulation Pathway of Clostridium difficile

PubMed Central

Fimlaid, Kelly A.; Bond, Jeffrey P.; Schutz, Kristin C.; Putnam, Emily E.; Leung, Jacqueline M.; Lawley, Trevor D.; Shen, Aimee

2013-01-01

The Gram-positive, spore-forming pathogen Clostridium difficile is the leading definable cause of healthcare-associated diarrhea worldwide. C. difficile infections are difficult to treat because of their frequent recurrence, which can cause life-threatening complications such as pseudomembranous colitis. The spores of C. difficile are responsible for these high rates of recurrence, since they are the major transmissive form of the organism and resistant to antibiotics and many disinfectants. Despite the importance of spores to the pathogenesis of C. difficile, little is known about their composition or formation. Based on studies in Bacillus subtilis and other Clostridium spp., the sigma factors σF, σE, σG, and σK are predicted to control the transcription of genes required for sporulation, although their specific functions vary depending on the organism. In order to determine the roles of σF, σE, σG, and σK in regulating C. difficile sporulation, we generated loss-of-function mutations in genes encoding these sporulation sigma factors and performed RNA-Sequencing to identify specific sigma factor-dependent genes. This analysis identified 224 genes whose expression was collectively activated by sporulation sigma factors: 183 were σF-dependent, 169 were σE-dependent, 34 were σG-dependent, and 31 were σK-dependent. In contrast with B. subtilis, C. difficile σE was dispensable for σG activation, σG was dispensable for σK activation, and σF was required for post-translationally activating σG. Collectively, these results provide the first genome-wide transcriptional analysis of genes induced by specific sporulation sigma factors in the Clostridia and highlight that diverse mechanisms regulate sporulation sigma factor activity in the Firmicutes. PMID:23950727

Global analysis of the sporulation pathway of Clostridium difficile.

PubMed

Fimlaid, Kelly A; Bond, Jeffrey P; Schutz, Kristin C; Putnam, Emily E; Leung, Jacqueline M; Lawley, Trevor D; Shen, Aimee

2013-01-01

The Gram-positive, spore-forming pathogen Clostridium difficile is the leading definable cause of healthcare-associated diarrhea worldwide. C. difficile infections are difficult to treat because of their frequent recurrence, which can cause life-threatening complications such as pseudomembranous colitis. The spores of C. difficile are responsible for these high rates of recurrence, since they are the major transmissive form of the organism and resistant to antibiotics and many disinfectants. Despite the importance of spores to the pathogenesis of C. difficile, little is known about their composition or formation. Based on studies in Bacillus subtilis and other Clostridium spp., the sigma factors σ(F), σ(E), σ(G), and σ(K) are predicted to control the transcription of genes required for sporulation, although their specific functions vary depending on the organism. In order to determine the roles of σ(F), σ(E), σ(G), and σ(K) in regulating C. difficile sporulation, we generated loss-of-function mutations in genes encoding these sporulation sigma factors and performed RNA-Sequencing to identify specific sigma factor-dependent genes. This analysis identified 224 genes whose expression was collectively activated by sporulation sigma factors: 183 were σ(F)-dependent, 169 were σ(E)-dependent, 34 were σ(G)-dependent, and 31 were σ(K)-dependent. In contrast with B. subtilis, C. difficile σ(E) was dispensable for σ(G) activation, σ(G) was dispensable for σ(K) activation, and σ(F) was required for post-translationally activating σ(G). Collectively, these results provide the first genome-wide transcriptional analysis of genes induced by specific sporulation sigma factors in the Clostridia and highlight that diverse mechanisms regulate sporulation sigma factor activity in the Firmicutes.

Organisational and extraorganisational determinants of volume of service delivery by English community pharmacies: a cross-sectional survey and secondary data analysis

PubMed Central

Hann, Mark; Schafheutle, Ellen I; Bradley, Fay; Elvey, Rebecca; Wagner, Andrew; Halsall, Devina; Hassell, Karen

2017-01-01

Objectives This study aimed to identify the organisational and extraorganisational factors associated with existing variation in the volume of services delivered by community pharmacies. Design and setting Linear and ordered logistic regression of linked national data from secondary sources—community pharmacy activity, socioeconomic and health need datasets—and primary data from a questionnaire survey of community pharmacies in nine diverse geographical areas in England. Outcome measures Annual dispensing volume; annual volume of medicines use reviews (MURs). Results National dataset (n=10 454 pharmacies): greater dispensing volume was significantly associated with pharmacy ownership type (large chains>independents>supermarkets), greater deprivation, higher local prevalence of cardiovascular disease and depression, older people (aged >75 years) and infants (aged 0–4 years) but lower prevalence of mental health conditions. Greater volume of MURs was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, and lower disease prevalence. Survey dataset (n=285 pharmacies; response=34.6%): greater dispensing volume was significantly associated with staffing, skill-mix, organisational culture, years open and greater deprivation. Greater MUR volume was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, weekly opening hours and lower asthma prevalence. Conclusions Organisational and extraorganisational factors were found to impact differently on dispensing volume and MUR activity, the latter being driven more by corporate ownership than population need. While levels of staffing and skill-mix were associated with dispensing volume, they did not influence MUR activity. Despite recent changes to the contractual framework, the existing fee-for-service reimbursement may therefore not be the most appropriate for the delivery of cognitive (rather than supply) services, still appearing to incentivise quantity over the quality (in terms of appropriate targeting) of services delivered. Future research should focus on the development of quality measures that could be incorporated into community pharmacy reimbursement mechanisms. PMID:29018074

Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.

PubMed

Wright, R Eric; Reed, Nia; Carnes, Neal; Kooreman, Harold E

2016-01-01

Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death. As the primary gatekeepers to the medications contributing to this epidemic, it is critical to understand the views of licensed health care professionals. In this study, we examine health care professionals' concern regarding prescription drug abuse in their communities and the impact their concern has had on their prescribing and dispensing practices. An online survey of licensed health care providers. Conducted in Indiana. This study was a state-wide evaluation of Indiana's prescription drug monitoring program. The questionnaire asked respondents how concerned they were about prescription drug abuse in their community. Variation in the level of concern was examined using ordinary least squares regression and information about the respondents' demographic background and clinical experience. In addition, we used logistic regression to examine whether concern was associated with changing prescribing and/or dispensing behavior. The majority of providers indicated they were "moderately" or "extremely concerned" about prescription drug abuse in their communities. The level of concern, however, varied significantly by profession, with pharmacists, physicians, nurse practitioners/physician assistants being more concerned than dentists. Additional analyses indicate that providers with higher levels of concern were those who also reported recently changing their prescribing and/or dispensing behavior. The voluntary nature and geographical focus of the study limits the generalizability of the findings. Concern about prescription drug abuse is generally high across the major health care professions; however, a significant minority of providers, particularly among dentists, expressed little or no concern about the epidemic. Increasing health care providers' general level of concern about prescription drug abuse may be an effective public health tool for encouraging voluntary reductions in prescribing and/or dispensing controlled substances.

Under-utilisation of preventive medication in patients with cardiovascular disease is greatest in younger age groups (PREDICT-CVD 15).

PubMed

Mehta, Suneela; Wells, Sue; Riddell, Tania; Kerr, Andrew; Pylypchuk, Romana; Marshall, Roger; Ameratunga, Shanthi; Chan, Wing Cheuk; Thornley, Simon; Crengle, Sue; Harrison, Jeff; Drury, Paul; Elley, C Raina; Bell, Fionna; Jackson, Rod

2011-06-01

Blood pressure-lowering (BPL) and lipid-lowering (LL) medications together reduce estimated absolute five-year cardiovascular disease (CVD) risk by >40%. International studies indicate that the proportion of people with CVD receiving pharmacotherapy increases with advancing age. To compare BPL and LL medications, by sociodemographic characteristics, for patients with known CVD in primary care settings. The study population included patients aged 35-74 with known CVD assessed in primary care from July 2006 to October 2009 using a web-based computerised decision support system (PREDICT) for risk assessment and management. Clinical data linked anonymously to national sociodemographic and pharmaceutical dispensing databases. Differences in dispensing BPL and LL medications in six months before first PREDICT assessment was analysed according to age, sex, ethnicity and deprivation. Of 7622 people with CVD, 1625 <55 years old, 2862 were women and 4609 lived in deprived areas (NZDep quintiles 4/5). The study population included 4249 European, 1556 Maori, 1151 Pacific and 329 Indian peoples. BPL medications were dispensed to 81%, LL medications to 73%, both BPL and LL medications to 67%, and 87% received either class of medication. Compared with people aged 65-75, people aged 35-44 were 30-40% less likely and those aged 45-54 were 10-15% less likely to be dispensed BPL, LL medications or both. There were minimal differences in likelihood of dispensing according to sex, ethnicity or deprivation. BPL and LL medications are under-utilised in patients with known CVD in New Zealand. Only two-thirds of patients in this cohort are on both. Younger patients are considerably less likely to be on recommended medications.

[About free delivery of therapeutical and preventive drugs to the people during Ottoman Empire].

PubMed

Cubukçu, B

2001-01-01

In this study, free delivery of medical drugs (dispensed in Ottoman Empire hospital pharmacies) to the outpatients in addition to the inpatients in Darüşşifas (patient care houses) have been investigated in the chronological order from the Vakfiye enrollments and documents of Ottoman Empire. On the other hand free delivery of drugs dispensed in the Palaces, Mesir paste delivery and other preventive drugs for the epidemic diseases have been studied.

48 CFR 37.116 - Accepting and Dispensing of $1 Coin.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Accepting and Dispensing of $1 Coin. 37.116 Section 37.116 Federal Acquisition Regulations System FEDERAL ACQUISITION... and Dispensing of $1 Coin. [72 FR 46362, Aug. 17, 2007] ...

48 CFR 37.116 - Accepting and Dispensing of $1 Coin.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Accepting and Dispensing of $1 Coin. 37.116 Section 37.116 Federal Acquisition Regulations System FEDERAL ACQUISITION... and Dispensing of $1 Coin. [72 FR 46362, Aug. 17, 2007] ...

14 CFR 121.333 - Supplemental oxygen for emergency descent and for first aid; turbine engine powered airplanes...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Supplemental oxygen for emergency descent..., FLAG, AND SUPPLEMENTAL OPERATIONS Instrument and Equipment Requirements § 121.333 Supplemental oxygen... shall furnish oxygen and dispensing equipment to comply with paragraphs (b) through (e) of this section...

14 CFR 121.333 - Supplemental oxygen for emergency descent and for first aid; turbine engine powered airplanes...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Supplemental oxygen for emergency descent..., FLAG, AND SUPPLEMENTAL OPERATIONS Instrument and Equipment Requirements § 121.333 Supplemental oxygen... shall furnish oxygen and dispensing equipment to comply with paragraphs (b) through (e) of this section...

14 CFR 121.333 - Supplemental oxygen for emergency descent and for first aid; turbine engine powered airplanes...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Supplemental oxygen for emergency descent..., FLAG, AND SUPPLEMENTAL OPERATIONS Instrument and Equipment Requirements § 121.333 Supplemental oxygen... shall furnish oxygen and dispensing equipment to comply with paragraphs (b) through (e) of this section...

77 FR 29691 - Matthew J. Kachinas, M.D.; Decision and Order

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-18

... Medicine, Registrant no longer holds authority to dispense controlled substances in Florida, the State in... lieu of a hearing. 21 CFR 1301.43(e). Accordingly, I issue this Decision and Order based on relevant evidence contained in the Investigative Record submitted by the Government. I make the following findings...

The t6A modification acts as a positive determinant for the anticodon nuclease PrrC, and is distinctively nonessential in Streptococcus mutans.

PubMed

Bacusmo, Jo Marie; Orsini, Silvia S; Hu, Jennifer; DeMott, Michael; Thiaville, Patrick C; Elfarash, Ameer; Paulines, Mellie June; Rojas-Benítez, Diego; Meineke, Birthe; Deutsch, Chris; Iwata-Reuyl, Dirk; Limbach, Patrick A; Dedon, Peter C; Rice, Kelly C; Shuman, Stewart; Crécy-Lagard, Valérie de

2017-07-20

Endoribonuclease toxins (ribotoxins) are produced by bacteria and fungi to respond to stress, eliminate non-self competitor species, or interdict virus infection. PrrC is a bacterial ribotoxin that targets and cleaves tRNA Lys UUU in the anticodon loop. In vitro studies suggested that the post-transcriptional modification threonylcarbamoyl adenosine (t 6 A) is required for PrrC activity but this prediction had never been validated in vivo. Here, by using t 6 A-deficient yeast derivatives, it is shown that t 6 A is a positive determinant for PrrC proteins from various bacterial species. Streptococcus mutans is one of the few bacteria where the t 6 A synthesis gene tsaE (brpB) is dispensable and its genome encodes a PrrC toxin. We had previously shown using an HPLC-based assay that the S. mutans tsaE mutant was devoid of t 6 A. However, we describe here a novel and a more sensitive hybridization-based t 6 A detection method (compared to HPLC) that showed t 6 A was still present in the S. mutans ΔtsaE, albeit at greatly reduced levels (93% reduced compared with WT). Moreover, mutants in 2 other S. mutans t 6 A synthesis genes (tsaB and tsaC) were shown to be totally devoid of the modification thus confirming its dispensability in this organism. Furthermore, analysis of t 6 A modification ratios and of t 6 A synthesis genes mRNA levels in S. mutans suggest they may be regulated by growth phase.

Impact of correcting visual impairment and low vision in deaf-mute students in Pune, India.

PubMed

Gogate, Parikshit; Bhusan, Shashi; Ray, Shantanu; Shinde, Amit

2016-12-01

The aim of this study was to evaluate visual acuity and vision function before and after providing spectacles and low vision devices (LVDs) in deaf-mute students. Schools for deaf-mute in West Maharashtra. Hearing-impaired children in all special schools in Pune district underwent detailed visual acuity testing (with teachers' help), refraction, external ocular examination, and fundoscopy. Students with refractive errors and low vision were provided with spectacles and LVD. The LV Prasad-Functional Vision Questionnaire consisting of twenty items was administered to each subject before and after providing spectacles, LVDs. Wilcoxon matched-pairs signed-ranks test. 252/929 (27.1%) students had a refractive error. 794 (85.5%) were profound deaf. Two-hundred and fifty students were dispensed spectacles and LVDs. Mean LogMAR visual acuity before introduction of spectacles and LVDs were 0.33 ± 0.36 which improved to 0.058 (P < 0.0001) after intervention. It was found that difference in functional vision pre- and post-intervention was statistically significant (P < 0.0001) for questions 1-19. The most commonly reported difficulties were for performing distance task like reading the bus destination (58.7%), making out the bus number (51.1%), copying from blackboard (47.7%), and seeing whether somebody is waving hand from across the road (45.5%). In response to question number 20, 57.4% of students felt that their vision was much worse than their friend's vision, which was reduced to 17.6% after dispensing spectacles and LVDs. Spectacle and LVD reduced visual impairment and improved vision function in deaf-mute students, augmenting their ability to negotiate in and out of school.

Differences in utilisation of gastroprotective drugs between 2001 and 2005 in Australia and Nova Scotia, Canada.

PubMed

Tett, Susan E; Sketris, Ingrid; Cooke, Charmaine; van Zanten, Sander Veldhuyzen; Barozzi, Nadia

2013-07-01

This study aimed to compare use of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), 2001-2005, in the elderly and social security beneficiaries in Australia (AUS) and Nova Scotia, Canada (NS). Prescription dispensing data were collected for all subsidised H2RAs and PPIs. In AUS, dispensing data for concession beneficiaries were obtained from the Pharmaceutical Benefits Scheme database. In NS, data were sourced from the Pharmacare database. Relevant population data were used to convert to World Health Organisation Anatomic Therapeutic Chemical defined daily doses (2005) per 1000 beneficiaries per day (DDD/1000/day). Overall use of gastroprotective agents was similar and rising in NS and AUS (100-160 DDD/1000/day) over this 5-year time window. However, the proportion of this use accounted for by PPIs was far higher in AUS (over 85% by 2005) than in NS (23% rising to 35% over the 5 years). In AUS, PPI use rose from 50 to about 140 DDD/1000/day over the 5 years, whereas PPI use in NS rose slowly to less than 60 DDD/1000/day by 2005. H2RA use in NS was always high (over 100 DDD/1000/day), whereas in AUS, H2RA use fell from 54 to around 24 DDD/1000/day over this period. AUS had much higher use of PPIs than NS over 2001-2005. The proportion of PPIs in all gastroprotective agents rose in AUS to be nearly 90%. The differences in utilisation during this time window could lead to differences in health outcomes from either lower gastro-intestinal bleeding risk or higher long-term adverse effects of PPIs. Copyright © 2013 John Wiley & Sons, Ltd.

77 FR 40355 - Workshop on Pet Medications Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-09

.... Others argue that licensed pharmacists are equally capable of dispensing pet medications to consumers, provided the pharmacists dispense the correct medication and dosage as prescribed by a veterinarian; these... dispensed by pharmacists appear less pronounced for OTC medications, which do not require a prescription and...

Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: A Cross Sectional Study

PubMed Central

2011-01-01

Background Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios. Methods A cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women). Results A total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases. Conclusions We observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted. PMID:21736711

Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: a cross sectional study.

PubMed

Bin Abdulhak, Aref A; Altannir, Mohamad A; Almansor, Mohammed A; Almohaya, Mohammed S; Onazi, Atallah S; Marei, Mohammed A; Aldossary, Oweida F; Obeidat, Sadek A; Obeidat, Mustafa A; Riaz, Muhammad S; Tleyjeh, Imad M

2011-07-07

Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios. A cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women). A total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases. We observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.

Improving access to medicines through centralised dispensing in the public sector: a case study of the Chronic Dispensing Unit in the Western Cape Province, South Africa.

PubMed

Magadzire, Bvudzai Priscilla; Marchal, Bruno; Ward, Kim

2015-11-17

The Chronic Dispensing Unit (CDU) is an out-sourced, public sector centralised dispensing service that has been operational in the Western Cape Province in South Africa since 2005. The CDU dispenses medicines for stable patients with chronic conditions. The aim is to reduce pharmacists' workload, reduce patient waiting times and decongest healthcare facilities. Our objectives are to describe the intervention's scope, illustrate its interface with the health system and describe its processes and outcomes. Secondly, to quantify the magnitude of missed appointments by enrolled patients and to describe the implications thereof in order to inform a subsequent in-depth empirical study on the underlying causes. We adopted a case study design in order to elicit the programme theory underlying the CDU strategy. We consulted 15 senior and middle managers from the provincial Department of Health who were working closely with the intervention and the contractor using focus group discussions and key informant interviews. In addition, relevant literature, and policy and programme documents were reviewed and analysed. We found that the CDU scope has significantly expanded over the last 10 years owing to technological advancements. As such, in early 2015, the CDU produced nearly 300,000 parcels monthly. Medicines supply, patient enrollment processes, healthcare professionals' compliance to legislation and policies, mechanisms for medicines distribution, management of non-collected medicines (emanating from patients' missed appointments) and the array of actors involved are all central to the CDU's functioning. Missed appointments by patients are a problem, affecting an estimated 8%-12% of patients each month. However, the causes have not been investigated thoroughly. Implications of missed appointments include a cost to government for services rendered by the contractor, potential losses due to expired medicines, additional workload for the contractor and healthcare facility staff and potential negative therapeutic outcomes for patients. The CDU demonstrates innovation in a context of overwhelming demand for dispensing medicines for chronic conditions. However, it is not a panacea to address access-to-medicines related challenges. A multi-level assessment that is currently underway will provide more insights on how existing challenges can be addressed.

Spin-on bottom antireflective coating defect reduction by proper filter selection and process optimization

NASA Astrophysics Data System (ADS)

Brakensiek, Nickolas L.; Kidd, Brian; Mesawich, Michael; Stevens, Don, Jr.; Gotlinsky, Barry

2003-06-01

A design of experiment (DOE) was implemented to show the effects of various point of use filters on the coat process. The DOE takes into account the filter media, pore size, and pumping means, such as dispense pressure, time, and spin speed. The coating was executed on a TEL Mark 8 coat track, with an IDI M450 pump, and PALL 16 stack Falcon filters. A KLA 2112 set at 0.69 μm pixel size was used to scan the wafers to detect and identify the defects. The process found for DUV42P to maintain a low defect coating irrespective of the filter or pore size is a high start pressure, low end pressure, low dispense time, and high dispense speed. The IDI M450 pump has the capability to compensate for bubble type defects by venting the defects out of the filter before the defects are in the dispense line and the variable dispense rate allows the material in the dispense line to slow down at the end of dispense and not create microbubbles in the dispense line or tip. Also the differential pressure sensor will alarm if the pressure differential across the filter increases over a user-determined setpoint. The pleat design allows more surface area in the same footprint to reduce the differential pressure across the filter and transport defects to the vent tube. The correct low defect coating process will maximize the advantage of reducing filter pore size or changing the filter media.

Behnken during Expedition 16 / STS-123 EVA 4

NASA Image and Video Library

2008-03-21

ISS016-E-033400 (21 March 2008) --- Astronaut Robert L. Behnken, STS-123 mission specialist, participates in the mission's fourth scheduled session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the 6-hour, 24-minute spacewalk, Behnken and astronaut Mike Foreman (out of frame), mission specialist, replaced a failed Remote Power Control Module -- essentially a circuit breaker -- on the station's truss. The spacewalkers also tested a repair method for damaged heat resistant tiles on the space shuttle. This technique used a caulk-gun-like tool named the Tile Repair Ablator Dispenser to dispense a material called Shuttle Tile Ablator-54 into purposely damaged heat shield tiles. The sample tiles will be returned to Earth to undergo extensive testing on the ground. A portion of the Space Shuttle Endeavour payload bay is visible in the background.

Antibiotic use, resistance development and environmental factors: a qualitative study among healthcare professionals in Orissa, India

PubMed Central

2010-01-01

Background Antibiotic resistance is a major public health problem affecting both current and future generations. The influence of environmental factors on antibiotic use and resistance development in bacteria is largely unknown. This study explored the perceptions of healthcare providers on antibiotic use and resistance development in relation to environmental factors i.e. physical, natural, social and behavioural factors. Methods A qualitative interview study was conducted using face-to-face, semi-structured interviews among registered allopathic doctors, veterinarians and drug dispensers in Orissa, India. The interview transcripts were analyzed using latent content analysis. Results The main findings of this study relate to two themes: 'Interrelationship between antibiotic use, resistance development and environment' and 'Antibiotic management contributing to the development and spread of resistance'. The interviewees viewed the following as possible contributors to antibiotic use/misuse and resistance development: changes in the natural and physical environment i.e. climate variability, pollution, physiography and population growth; the socioeconomic environment affecting health-seeking behaviour and noncompliance with medication; a lack of healthcare facilities and poor professional attitudes; and ineffective law enforcement regarding medicine dispensing and disposal. Conclusions Generally, the interviewees perceived that although behavioural and social environmental factors are major contributors to resistance development, changes in the physical and natural environment also influence development of antibiotic resistance. The respondents also perceived that there is a lack of information about, and poor awareness of, what constitutes prudent use of antibiotics. They suggested a need for information, education, dissemination and proper implementation and enforcement of legislation at all levels of the drug delivery and disposal system in order to improve antibiotic use and prevent pharmaceutical contamination of the environment. PMID:20964815

WHC Dose pump R&R

NASA Image and Video Library

2012-10-02

ISS033-E-009153 (2 Oct. 2012) --- Japan Aerospace Exploration Agency astronaut Aki Hoshide, Expedition 33 flight engineer, performs a removal and replacement of the DKiV water pump and the E-K pre-treat tank with its hose in the Tranquility node of the International Space Station. E-K contains five liters of pre-treat solution, i.e., a mix of H2SO4 (sulfuric acid), CrO3 (chromium oxide, for oxidation and purple color) and H2O (water). The pre-treat liquid is mixed with water in the DKiV dispenser and used for toilet flushing.

21 CFR 1306.11 - Requirement of prescription.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FR 16307, Mar. 31, 2010. (a) A pharmacist may dispense directly a controlled substance listed in... written, signed prescription is presented to the pharmacist for review prior to the actual dispensing of....10 of this title, a pharmacist may dispense a controlled substance listed in Schedule II upon...

Implantable Drug Dispenser

NASA Technical Reports Server (NTRS)

Collins, E. R. J.

1983-01-01

Drugs such as insulin are injected as needed directly into bloodstream by compact implantable dispensing unit. Two vapor cavities produce opposing forces on drug-chamber diaphragm. Heaters in cavities allow control of direction and rate of motion of bellows. Dispensing capsule fitted with coil so batteries can be recharged by induction.

16 CFR 309.11 - Certification.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Manufacturers of Electric Vehicle Fuel Dispensing Systems § 309.11 Certification. (a) For non-liquid alternative... certification. (b) For electric vehicle fuel dispensing systems, in each transfer you make to anyone who is not a consumer, you must certify the fuel rating of the electric vehicle fuel dispensing system...

16 CFR 309.11 - Certification.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Manufacturers of Electric Vehicle Fuel Dispensing Systems § 309.11 Certification. (a) For non-liquid alternative... certification. (b) For electric vehicle fuel dispensing systems, in each transfer you make to anyone who is not a consumer, you must certify the fuel rating of the electric vehicle fuel dispensing system...

16 CFR 309.11 - Certification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Manufacturers of Electric Vehicle Fuel Dispensing Systems § 309.11 Certification. (a) For non-liquid alternative... certification. (b) For electric vehicle fuel dispensing systems, in each transfer you make to anyone who is not a consumer, you must certify the fuel rating of the electric vehicle fuel dispensing system...

16 CFR 309.11 - Certification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Manufacturers of Electric Vehicle Fuel Dispensing Systems § 309.11 Certification. (a) For non-liquid alternative... certification. (b) For electric vehicle fuel dispensing systems, in each transfer you make to anyone who is not a consumer, you must certify the fuel rating of the electric vehicle fuel dispensing system...

High mass throughput particle generation using multiple nozzle spraying

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pui, David Y. H.; Chen, Da-Ren

Spraying apparatus and methods that employ multiple nozzle structures for producing multiple sprays of particles, e.g., nanoparticles, for various applications, e.g., pharmaceuticals, are provided. For example, an electrospray dispensing device may include a plurality of nozzle structures, wherein each nozzle structure is separated from adjacent nozzle structures by an internozzle distance. Sprays of particles are established from the nozzle structures by creating a nonuniform electrical field between the nozzle structures and an electrode electrically isolated therefrom.

Application of an industrial robot to nuclear pharmacy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Viola, J.

1994-12-31

Increased patient throughput and lengthened P.E.T. scan protocols have increased the radiation dose received by P.E.T. technologists. Automated methods of tracer infusion and blood sampling have been introduced to reduce direct contact with the radioisotopes, but significant radiation exposure still exists during the receipt and dispensing of the patient dose. To address this situation the authors have developed an automated robotic system which performs these tasks, thus limiting the physical contact between operator and radioisotope.

High mass throughput particle generation using multiple nozzle spraying

DOEpatents

Pui, David Y.H.; Chen, Da-Ren

2004-07-20

Spraying apparatus and methods that employ multiple nozzle structures for producing multiple sprays of particles, e.g., nanoparticles, for various applications, e.g., pharmaceuticals, are provided. For example, an electrospray dispensing device may include a plurality of nozzle structures, wherein each nozzle structure is separated from adjacent nozzle structures by an internozzle distance. Sprays of particles are established from the nozzle structures by creating a nonuniform electrical field between the nozzle structures and an electrode electrically isolated therefrom.

High mass throughput particle generation using multiple nozzle spraying

DOEpatents

Pui, David Y. H. [Plymouth, MN; Chen, Da-Ren [Creve Coeur, MO

2009-03-03

Spraying apparatus and methods that employ multiple nozzle structures for producing multiple sprays of particles, e.g., nanoparticles, for various applications, e.g., pharmaceuticals, are provided. For example, an electrospray dispensing device may include a plurality of nozzle structures, wherein each nozzle structure is separated from adjacent nozzle structures by an internozzle distance. Sprays of particles are established from the nozzle structures by creating a nonuniform electrical field between the nozzle structures and an electrode electrically isolated therefrom.

Surveillance of life-long antibiotics: a review of antibiotic prescribing practices in an Australian Healthcare Network.

PubMed

Lau, Jillian S Y; Kiss, Christopher; Roberts, Erika; Horne, Kylie; Korman, Tony M; Woolley, Ian

2017-01-18

The rise of antimicrobial use in the twentieth century has significantly reduced morbidity due to infection, however it has also brought with it the rise of increasing resistance. Some patients are on prolonged, if not "life-long" course of antibiotics. The reasons for this are varied, and include non-infectious indications. We aimed to study the characteristics of this potential source of antibiotic resistance, by exploring the antibiotic dispensing practices and describing the population of patients on long-term antibiotic therapy. A retrospective cross-sectional study of antibiotic dispensing records was performed at a large university hospital-based healthcare network in Melbourne, Australia. Outpatient prescriptions were extracted from the hospital pharmacy database over a 6 month period in 2014. Medical records of these patients were reviewed to determine the indication for prescription, including microbiology, the intended duration, and the prescribing unit. A descriptive analysis was performed on this data. 66,127 dispensing episodes were reviewed. 202 patients were found to have been prescribed 1 or more antibiotics with an intended duration of 1 year or longer. 69/202 (34%) of these patients were prescribed prolonged antibiotics for primary prophylaxis in the setting of immunosuppression. 43/202 (21%) patients were prescribed long-term suppressive antibiotics for infections of thought incurable (e.g. vascular graft infections), and 34/43 (79%) were prescribed by Infectious Diseases doctors. 66/202 (33%) patients with cystic fibrosis were prescribed prolonged courses of macrolides or fluoroquinolones, by respiratory physicians. There was great heterogeneity noted in indications for prolonged antibiotic courses, as well as antibiotic agents utilised. Our study found that that continuous antibiotic therapy represented only a small proportion of overall antibiotic prescribing at our health network. Prolonged courses of antibiotics were used mainly to suppress infections thought incurable, but also as primary and secondary prophylaxis and as anti-inflammatory agents. More research is needed to understand the impact of long-term antibiotic consumption on both patients and microbial ecology.

Real-world fuel use and gaseous emission rates for flex fuel vehicles operated on E85 versus gasoline.

PubMed

Delavarrafiee, Maryam; Frey, H Christopher

2018-03-01

Flex fuel vehicles (FFVs) typically operate on gasoline or E85, an 85%/15% volume blend of ethanol and gasoline. Differences in FFV fuel use and tailpipe emission rates are quantified for E85 versus gasoline based on real-world measurements of five FFVs with a portable emissions measurement system (PEMS), supplemented chassis dynamometer data, and estimates from the Motor Vehicle Emission Simulator (MOVES) model. Because of inter-vehicle variability, an individual FFV may have higher nitrogen oxide (NO x ) or carbon monoxide (CO) emission rates on E85 versus gasoline, even though average rates are lower. Based on PEMS data, the comparison of tailpipe emission rates for E85 versus gasoline is sensitive to vehicle-specific power (VSP). For example, although CO emission rates are lower for all VSP modes, they are proportionally lowest at higher VSP. Driving cycles with high power demand are more advantageous with respect to CO emissions, but less advantageous for NO x . Chassis dynamometer data are available for 121 FFVs at 50,000 useful life miles. Based on the dynamometer data, the average difference in tailpipe emissions for E85 versus gasoline is -23% for NO x , -30% for CO, and no significant difference for hydrocarbons (HC). To account for both the fuel cycle and tailpipe emissions from the vehicle, a life cycle inventory was conducted. Although tailpipe NO x emissions are lower for E85 versus gasoline for FFVs and thus benefit areas where the vehicles operate, the life cycle NO x emissions are higher because the NO x emissions generated during fuel production are higher. The fuel production emissions take place typically in rural areas. Although there are not significant differences in the total HC emissions, there are differences in HC speciation. The net effect of lower tailpipe NO x emissions and differences in HC speciation on ozone formation should be further evaluated. Reported comparisons of flex fuel vehicle (FFV) tailpipe emission rates for E85 versus gasoline have been inconsistent. To date, this is the most comprehensive evaluation of available and new data. The large range of inter-vehicle variability illustrates why prior studies based on small sample sizes led to apparently contradictory findings. E85 leads to significant reductions in tailpipe nitrogen oxide (NO x ) and carbon monoxide (CO) emission rates compared with gasoline, indicating a potential benefit for ozone air quality management in NO x -limited areas. The comparison of FFV tailpipe emissions between E85 and gasoline is sensitive to power demand and driving cycles.

Mating disruption of citrus leafminer mediated by a noncompetitive mechanism at a remarkably low pheromone release rate.

PubMed

Stelinski, L L; Miller, J R; Rogers, M E

2008-08-01

The citrus leafminer, Phyllocnistis citrella Stainton (Lepidoptera: Gracillariidae), is a worldwide pest of citrus. A season-long investigation was conducted that evaluated mating disruption for this pest. Effective disruption of the male P. citrella orientation to pheromone traps (98%) and reduced flush infestation by larvae was achieved for 221 d with two deployments of a 3:1 blend of (Z,Z,E)-7,11,13-hexadecatrienal/(Z,Z)-7,11-hexadecadienal at a remarkably low rate of 1.5 g active ingredient (AI)/ha per deployment. To gain insight into the mechanism that mediates the disruption of P. citrella, male moth catch was quantified in replicated plots of citrus treated with varying densities of pheromone dispensers. The densities of septum dispensers compared were: 0 (0/ha, 0.0 g AI/ha), 0.2 (one every fifth tree or 35/ha, 0.05 g AI/ha), 1 (215/ha, 0.29 g AI/ha), and 5 per tree (1,100/ha, 1.5 g AI/ha). Profile analysis by previously published mathematical methods matched predictions of noncompetitive mating disruption. Behavioral observations of male P. citrella in the field revealed that males did not approach mating disruption dispensers in any of the dispenser density treatments. The current report presents the first set of profile analyses combined with direct behavioral observations consistent with previously published theoretical predictions for a noncompetitive mechanism of mating disruption. The results suggest that disruption of P. citrella should be effective even at high population densities given the density-independent nature of disruption for this species and the remarkably low rate of pheromone per hectare required for efficacy.

Measurement and reduction of micro-bubble formation in high-viscosity fluids

NASA Astrophysics Data System (ADS)

Tom, Glenn; Liu, Wei

2012-03-01

Gases at high drive pressure can initially dissolve into the fluids used in lithography and other critical processes during the fabrication of integrated circuits. In the low pressure portion of the dispense train, the dissolved gases can revert to bubbles. These bubbles can: 1. Affect the compressibility of the working fluid and change the flow characteristics of the dispense heads which require frequent re-tuning of the coating tools. 2. Contribute to defect formation if the bubbles are trapped on the surface of the wafer. Photosensitive Polyimides (PI) have high viscosities (1000 to 20,000 cP). Because of the high viscosity, high-powered, expensive pumps are needed to effectively remove the fluid from its container. Suction from the pump filling cycle easily causes cavitation, which can create flow rate variability, and micro-bubble formation. It is a common practice to apply pressure to the PI resists to minimize cavitation in the pump. The trade-off to this practice is the entrainment (dissolution) of the drive gas into the resist and the risk of micro-bubbles forming later in the dispense train. In the current study, ATMI measured the effects of two methods of pressure dispense from the container on the amount of gas entrained in a viscous fluid: (1) indirect pressure dispense and (2) direct pressure dispense. The main analytical method employed to measure the amount of dissolved gases is a gas chromatograph (GC), which can measure the concentration of gases dissolved in a volatile fluid. It is not suitable to measure gases in low volatility fluids. The new test method developed, however, is capable of measuring dissolved gases in low volatility fluids.

Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study

PubMed Central

Srigley, Jocelyn A; Furness, Colin D; Baker, G Ross; Gardam, Michael

2014-01-01

Background The Hawthorne effect, or behaviour change due to awareness of being observed, is assumed to inflate hand hygiene compliance rates as measured by direct observation but there are limited data to support this. Objective To determine whether the presence of hand hygiene auditors was associated with an increase in hand hygiene events as measured by a real-time location system (RTLS). Methods The RTLS recorded all uses of alcohol-based hand rub and soap for 8 months in two units in an academic acute care hospital. The RTLS also tracked the movement of hospital hand hygiene auditors. Rates of hand hygiene events per dispenser per hour as measured by the RTLS were compared for dispensers within sight of auditors and those not exposed to auditors. Results The hand hygiene event rate in dispensers visible to auditors (3.75/dispenser/h) was significantly higher than in dispensers not visible to the auditors at the same time (1.48; p=0.001) and in the same dispensers during the week prior (1.07; p<0.001). The rate increased significantly when auditors were present compared with 1–5 min prior to the auditors’ arrival (1.50; p=0.009). There were no significant changes inside patient rooms. Conclusions Hand hygiene event rates were approximately threefold higher in hallways within eyesight of an auditor compared with when no auditor was visible and the increase occurred after the auditors’ arrival. This is consistent with the existence of a Hawthorne effect localised to areas where the auditor is visible and calls into question the accuracy of publicly reported hospital hand hygiene compliance rates. PMID:25002555

Robotic dispensing of composite scaffolds and in vitro responses of bone marrow stromal cells.

PubMed

Hong, Seok-Jung; Jeong, Ishik; Noh, Kyung-Tae; Yu, Hye-Sun; Lee, Gil-Su; Kim, Hae-Won

2009-09-01

The development of bioactive scaffolds with a designed pore configuration is of particular importance in bone tissue engineering. In this study, bone scaffolds with a controlled pore structure and a bioactive composition were produced using a robotic dispensing technique. A poly(epsilon-caprolactone) (PCL) and hydroxyapatite (HA) composite solution (PCL/HA = 1) was constructed into a 3-dimensional (3D) porous scaffold by fiber deposition and layer-by-layer assembly using a computer-aided robocasting machine. The in vitro tissue cell compatibility was examined using rat bone marrow stromal cells (rBMSCs). The adhesion and growth of cells onto the robotic dispensed scaffolds were observed to be limited by applying the conventional cell seeding technique. However, the initially adhered cells were viable on the scaffold surface. The alkaline phosphatase activity of the cells was significantly higher on the HA-PCL than on the PCL and control culture dish, suggesting that the robotic dispensed HA-PCL scaffold should stimulate the osteogenic differentiation of rBMSCs. Moreover, the expression of a series of bone-associated genes, including alkaline phosphatase and collagen type I, was highly up-regulated on the HA-PCL scaffold as compared to that on the pure PCL scaffold. Overall, the robotic dispensed HA-PCL is considered to find potential use as a bioactive 3D scaffold for bone tissue engineering.

Efficacy Evaluation of a non-contact automatic articulating paper dispenser in controlling articulating paper microbial contamination

PubMed Central

Li, Yajin; Chen, Litong; Yuan, Fusong; Li, Yugui; Zhou, Yongsheng; Sun, Yuchun

2017-01-01

This study is to quantitatively evaluate the efficacy of using a non-contact automatic articulating paper dispenser for reducing microbial articulating paper contamination. Articulating papers in four-handed mode, non-four-handed mode, and via an automatic articulating paper dispenser were evaluated. An adenosine triphosphate bioluminescence assay was used to quantitatively measure the relative light unit (RLU) values of the rest unused articulating papers in the same package to detect contamination at 4 time points, and triplicate examinations were performed for all three methods. The RLUs were recorded, compared, and evaluated. For four-handed mode (n = 36), the RLUs at the four time points were 2.44, 32.89, 37.89, and 27.22, with a satisfactory rate of 94%. The RLUs for non-four-handed mode (n = 36) were 2.22, 286.44, 299.44, and 493.56, with a satisfactory rate of 36%. The RLUs for using the automatic dispenser (n = 36) were all 0 with a satisfactory rate of 100%. The satisfactory rates were significantly different among three methods. No significant differences were observed in the satisfactory rates for the four time points samples. Contact by gloved hands can cause severe biological contamination of articulating paper. However, by using standard four-handed mode or a non-contact automatic articulating paper dispenser, contamination can be controlled. PMID:28466846

Part 1. Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016.

PubMed

Teoh, L; Stewart, K; Marino, R J; McCullough, M J

2018-05-13

Literature has shown dentists tend to overprescribe antibiotics and do not always prescribe in accordance with recommended guidelines. Unnecessary prescribing is one major factor that contributes to the development of antibiotic resistance. The aim of the present study was to assess the antibacterial prescribing patterns of dentists in Australia from 2013 to 2016. Data on dental antibacterial prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) from 2013 to 2016 was accessed and prescribing trends analysed. The prescribing rates were standardised to the dose and population. There was a slight decrease in the dispensed use of most antibacterials from 2013-16, but there was a significant increase in the dispensed use of amoxicillin/clavulanic acid of 11.2%. Amoxicillin was the most commonly dispensed antibiotic, accounting for around 65% of all antibacterials from 2013-16, while phenoxymethylpenicillin accounted for only 1.4% of prescriptions in 2016. There were low but significant quantities of dispensed antibiotic prescriptions that do not fit with current guidelines. The data suggest that dentists in Australia are prescribing some antibiotics inappropriately and there is a preference for moderate to broad spectrum agents. The current PBS dental schedule is inconsistent with prescribing guidelines and may contribute to inappropriate prescribing. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Platelets are dispensable for antibody-mediated transfusion-related acute lung injury in the mouse.

PubMed

Hechler, B; Maître, B; Magnenat, S; Heim, V; El Mdawar, M-B; Gachet, C; de la Salle, H

2016-06-01

Essentials Role of platelets in immunological transfusion-related acute lung injury (TRALI) is debated. Immunological TRALI was tested in mice exhibiting severe thrombocytopenia or platelet dysfunction. Platelets are required to prevent lung hemorrhage but not edema formation and respiratory distress. Platelets are dispensable for the initiation and development of TRALI. Background Transfusion-related acute lung injury (TRALI) is a serious transfusion-related complication. Previous conflicting studies have indicated that platelets are either crucial or dispensable for TRALI. Objectives To evaluate the role of platelets in major histocompatibility complex (MHC) I-induced-TRALI. Methods Antibody-mediated TRALI was experimentally induced in mice by lipopolysaccharide priming followed by the administration of an anti-MHC I mAb. Results TRALI was tested in the context of severe thrombocytopenia provoked by the administration of diphtheria toxin (DT) in transgenic iDTR mice selectively expressing DT receptor in megakaryocytes. The pathologic responses occurring within the first 10 min following the injection of the anti-MHC I mAb, i.e. the severity of lung edema and the drop in aortic blood oxygenation, were similar in severely thrombocytopenic DT-iDTR and control mice. At later times, mortality was nevertheless increased in DT-iDTR mice, owing to lung hemorrhages. When less severe thrombocytopenia was induced with an antiplatelet mAb, TRALI started and developed similarly as in control mice, but hemorrhages were absent. Furthermore, when platelet functions were defective because of administration of aspirin or clopidogrel, or because of glycoprotein (GP)IIbIIIa deficiency, TRALI still developed but no lung hemorrhages were observed. In contrast, when GPVI was immunodepleted, TRALI still occurred, but was occasionally accompanied by hemorrhages. Conclusions Platelets are dispensable for the initiation and development of MHC I-induced TRALI. Although they do not protect against the disruption of the vascular endothelial cell barrier and the subsequent plasma leakage and edema formation, platelets are essential to prevent more serious damage resulting in hemorrhages in alveoli. © 2016 International Society on Thrombosis and Haemostasis.

Effects of Televised Direct-to-Consumer Advertising for Varenicline on Prescription Dispensing in the United States, 2006-2009.

PubMed

Kim, Yoonsang; Kornfield, Rachel; Shi, Yaru; Vera, Lisa; Daubresse, Matthew; Alexander, G Caleb; Emery, Sherry

2016-05-01

Televised direct-to-consumer advertising (DTCA) for prescription drugs is controversial, especially for tobacco cessation products such as varenicline, given safety concerns that arose only after its market approval. We aim to quantify the extent to which DTCA influenced varenicline use. We linked monthly DTCA television ratings with monthly prescription data from IMS Health's National Prescription Audit across top 75 media markets in 2006-2009. We used Poisson models with Generalized Estimating Equations to analyze effects of exposures to DTCA for both varenicline and nicotine replacement therapies on rate of dispensed varenicline prescriptions among smokers, controlling for population characteristics and varenicline-related events. Varenicline prescriptions increased dramatically following DTCA launch and declined sharply after safety risks were publicized and US Food and Drug Administration (FDA) issued an advisory. DTCA had significant impact on new prescription dispensing in the subsequent month: before the FDA advisory, one additional exposure to varenicline DTCA was associated with a 1.8% (rate ratio [RR] = 1.018 [1.015-1.021]) higher rate of new prescriptions; no effect was observed after the advisory (RR = 1.000 [0.997-1.003]). Prior to the advisory, cross-product effects of nicotine replacement therapy advertising on varenicline prescribing were negligible (RR = 1.002 [0.999-1.004]); after the advisory, effects were positive (RR = 1.015 [1.012-1.019]). DTCA for varenicline had a significant impact on varenicline prescribing when the drug's safety profile was not well characterized, supporting arguments to limit DTCA for newly approved products whose real-world safety is unclear. We examined the fluctuations in varenicline use in association with DTCA for varenicline and other tobacco cessation aids. To our knowledge this is the first study to quantify the effects of televised DTCA for varenicline and other tobacco cessation aids on varenicline prescription dispensing. We believe that understanding these relationships is critical for formulating effective public health policy and interventions. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Integrating historical clinical and financial data for pharmacological research.

PubMed

Deshmukh, Vikrant G; Sower, N Brett; Hunter, Cheri Y; Mitchell, Joyce A

2011-11-18

Retrospective research requires longitudinal data, and repositories derived from electronic health records (EHR) can be sources of such data. With Health Information Technology for Economic and Clinical Health (HITECH) Act meaningful use provisions, many institutions are expected to adopt EHRs, but may be left with large amounts of financial and historical clinical data, which can differ significantly from data obtained from newer systems, due to lack or inconsistent use of controlled medical terminologies (CMT) in older systems. We examined different approaches for semantic enrichment of financial data with CMT, and integration of clinical data from disparate historical and current sources for research. Snapshots of financial data from 1999, 2004 and 2009 were mapped automatically to the current inpatient pharmacy catalog, and enriched with RxNorm. Administrative metadata from financial and dispensing systems, RxNorm and two commercial pharmacy vocabularies were used to integrate data from current and historical inpatient pharmacy modules, and the outpatient EHR. Data integration approaches were compared using percentages of automated matches, and effects on cohort size of a retrospective study. During 1999-2009, 71.52%-90.08% of items in use from the financial catalog were enriched using RxNorm; 64.95%-70.37% of items in use from the historical inpatient system were integrated using RxNorm, 85.96%-91.67% using a commercial vocabulary, 87.19%-94.23% using financial metadata, and 77.20%-94.68% using dispensing metadata. During 1999-2009, 48.01%-30.72% of items in use from the outpatient catalog were integrated using RxNorm, and 79.27%-48.60% using a commercial vocabulary. In a cohort of 16304 inpatients obtained from clinical systems, 4172 (25.58%) were found exclusively through integration of historical clinical data, while 15978 (98%) could be identified using semantically enriched financial data. Data integration using metadata from financial/dispensing systems and pharmacy vocabularies were comparable. Given the current state of EHR adoption, semantic enrichment of financial data and integration of historical clinical data would allow the repurposing of these data for research. With the push for HITECH meaningful use, institutions that are transitioning to newer EHRs will be able to use their older financial and clinical data for research using these methods.

Integrating historical clinical and financial data for pharmacological research

PubMed Central

2011-01-01

Background Retrospective research requires longitudinal data, and repositories derived from electronic health records (EHR) can be sources of such data. With Health Information Technology for Economic and Clinical Health (HITECH) Act meaningful use provisions, many institutions are expected to adopt EHRs, but may be left with large amounts of financial and historical clinical data, which can differ significantly from data obtained from newer systems, due to lack or inconsistent use of controlled medical terminologies (CMT) in older systems. We examined different approaches for semantic enrichment of financial data with CMT, and integration of clinical data from disparate historical and current sources for research. Methods Snapshots of financial data from 1999, 2004 and 2009 were mapped automatically to the current inpatient pharmacy catalog, and enriched with RxNorm. Administrative metadata from financial and dispensing systems, RxNorm and two commercial pharmacy vocabularies were used to integrate data from current and historical inpatient pharmacy modules, and the outpatient EHR. Data integration approaches were compared using percentages of automated matches, and effects on cohort size of a retrospective study. Results During 1999-2009, 71.52%-90.08% of items in use from the financial catalog were enriched using RxNorm; 64.95%-70.37% of items in use from the historical inpatient system were integrated using RxNorm, 85.96%-91.67% using a commercial vocabulary, 87.19%-94.23% using financial metadata, and 77.20%-94.68% using dispensing metadata. During 1999-2009, 48.01%-30.72% of items in use from the outpatient catalog were integrated using RxNorm, and 79.27%-48.60% using a commercial vocabulary. In a cohort of 16304 inpatients obtained from clinical systems, 4172 (25.58%) were found exclusively through integration of historical clinical data, while 15978 (98%) could be identified using semantically enriched financial data. Conclusions Data integration using metadata from financial/dispensing systems and pharmacy vocabularies were comparable. Given the current state of EHR adoption, semantic enrichment of financial data and integration of historical clinical data would allow the repurposing of these data for research. With the push for HITECH meaningful use, institutions that are transitioning to newer EHRs will be able to use their older financial and clinical data for research using these methods. PMID:22099213

21 CFR 1306.26 - Dispensing without prescription.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Federal Food, Drug, and Cosmetic Act, may be dispensed by a pharmacist without a prescription to a purchaser at retail, provided that: (a) Such dispensing is made only by a pharmacist (as defined in part... pharmacist (although after the pharmacist has fulfilled his professional and legal responsibilities set forth...

21 CFR 1306.26 - Dispensing without prescription.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Federal Food, Drug, and Cosmetic Act, may be dispensed by a pharmacist without a prescription to a purchaser at retail, provided that: (a) Such dispensing is made only by a pharmacist (as defined in part... pharmacist (although after the pharmacist has fulfilled his professional and legal responsibilities set forth...

21 CFR 1306.26 - Dispensing without prescription.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Federal Food, Drug, and Cosmetic Act, may be dispensed by a pharmacist without a prescription to a purchaser at retail, provided that: (a) Such dispensing is made only by a pharmacist (as defined in part... pharmacist (although after the pharmacist has fulfilled his professional and legal responsibilities set forth...

21 CFR 1306.26 - Dispensing without prescription.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Federal Food, Drug, and Cosmetic Act, may be dispensed by a pharmacist without a prescription to a purchaser at retail, provided that: (a) Such dispensing is made only by a pharmacist (as defined in part... pharmacist (although after the pharmacist has fulfilled his professional and legal responsibilities set forth...

21 CFR 1306.26 - Dispensing without prescription.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Federal Food, Drug, and Cosmetic Act, may be dispensed by a pharmacist without a prescription to a purchaser at retail, provided that: (a) Such dispensing is made only by a pharmacist (as defined in part... pharmacist (although after the pharmacist has fulfilled his professional and legal responsibilities set forth...

77 FR 58840 - Request for Comments and Announcement of Workshop on Pet Medications Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-24

... medications to their clients. Others argue that licensed pharmacists are equally capable of dispensing pet medications to consumers, provided the pharmacists dispense the correct medication and dosage as prescribed by... safety of pet medications dispensed by pharmacists appear less pronounced for OTC medications, which do...

14 CFR 137.39 - Economic poison dispensing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Economic poison dispensing. 137.39 Section... AIRCRAFT OPERATIONS Operating Rules § 137.39 Economic poison dispensing. (a) Except as provided in... economic poison that is registered with the U.S. Department of Agriculture under the Federal Insecticide...

76 FR 20850 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Stage I Vapor Recovery Rule

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-14

... gasoline dispensing facilities more stringent by applying them statewide, making the rule applicable to... Emissions Standards for Hazardous Air Pollutants (NESHAPs) for gasoline dispensing facilities. The revisions... January 10, 2008, EPA issued new, more stringent National Regulations for Gasoline Dispensing Facilities...

30 CFR 75.1905 - Dispensing of diesel fuel.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Dispensing of diesel fuel. 75.1905 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Diesel-Powered Equipment § 75.1905 Dispensing of diesel fuel. (a) Diesel-powered equipment in underground coal mines may be refueled only from safety cans...

30 CFR 75.1905 - Dispensing of diesel fuel.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Dispensing of diesel fuel. 75.1905 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Diesel-Powered Equipment § 75.1905 Dispensing of diesel fuel. (a) Diesel-powered equipment in underground coal mines may be refueled only from safety cans...

14 CFR 137.39 - Economic poison dispensing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Economic poison dispensing. 137.39 Section... AIRCRAFT OPERATIONS Operating Rules § 137.39 Economic poison dispensing. (a) Except as provided in... economic poison that is registered with the U.S. Department of Agriculture under the Federal Insecticide...

14 CFR 137.39 - Economic poison dispensing.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Economic poison dispensing. 137.39 Section... AIRCRAFT OPERATIONS Operating Rules § 137.39 Economic poison dispensing. (a) Except as provided in... economic poison that is registered with the U.S. Department of Agriculture under the Federal Insecticide...

14 CFR 137.39 - Economic poison dispensing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Economic poison dispensing. 137.39 Section... AIRCRAFT OPERATIONS Operating Rules § 137.39 Economic poison dispensing. (a) Except as provided in... economic poison that is registered with the U.S. Department of Agriculture under the Federal Insecticide...

14 CFR 137.39 - Economic poison dispensing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Economic poison dispensing. 137.39 Section... AIRCRAFT OPERATIONS Operating Rules § 137.39 Economic poison dispensing. (a) Except as provided in... economic poison that is registered with the U.S. Department of Agriculture under the Federal Insecticide...

Resin-Powder Dispenser

NASA Technical Reports Server (NTRS)

Standfield, Clarence E.

1994-01-01

Resin-powder dispenser used at NASA's Langley Research Center for processing of composite-material prepregs. Dispenser evenly distributes powder (resin polymer and other matrix materials in powder form) onto wet uncured prepregs. Provides versatility in distribution of solid resin in prepreg operation. Used wherever there is requirement for even, continuous distribution of small amount of powder.

Apparatus for dispensing material

DOEpatents

Sutter, Peter Werner [Beach, NY; Sutter, Eli Anguelova [Beach, NY

2011-07-05

An apparatus capable of dispensing drops of material with volumes on the order of zeptoliters is described. In some embodiments of the inventive pipette the size of the droplets so dispensed is determined by the size of a hole, or channel, through a carbon shell encapsulating a reservoir that contains material to be dispensed. The channel may be formed by irradiation with an electron beam or other high-energy beam capable of focusing to a spot size less than about 5 nanometers. In some embodiments, the dispensed droplet remains attached to the pipette by a small thread of material, an atomic scale meniscus, forming a virtually free-standing droplet. In some embodiments the droplet may wet the pipette tip and take on attributes of supported drops. Methods for fabricating and using the pipette are also described.

The role of pharmacists and emergency contraception: Are pharmacists' perceptions of emergency contraception predictive of their dispensing practices?

PubMed

Richman, Alice R; Daley, Ellen M; Baldwin, Julie; Kromrey, Jeff; O'Rourke, Kathleen; Perrin, Kay

2012-10-01

Pharmacists can play a critical role in the access to emergency contraception (EC). We assessed if knowledge and attitudes were predictive of EC dispensing among a statewide sample of Florida pharmacists, who have legal authority to refuse to dispense medications. In 2008, surveys were mailed to a random sample of 1264 pharmacists registered with the Florida Board of Pharmacy. Data from 272 pharmacists (22% response rate) were analyzed using bivariate and multivariate logistic regression. Fifty-six percent of respondents incorrectly answered that EC causes birth defects, and 46% replied that it causes abortion. Only 22% said that EC can be purchased in advance of need. Many felt uncomfortable dispensing to adolescents (61%) and men (58%). Knowledge about EC was the most important predictor of dispensing [odds ratio (OR)=1.57, 95% confidence interval (CI) 1.22-2.03]. In particular, pharmacists who reported that EC does not act as an abortifacient were more likely to dispense it (OR=4.64, 95% CI 2.15-10.00). Correct information about EC was the most important predictor of pharmacists' dispensing EC. To expand availability of EC, pharmacists will have to become better informed. Copyright © 2012 Elsevier Inc. All rights reserved.

ARAS: an automated radioactivity aliquoting system for dispensing solutions containing positron-emitting radioisotopes

DOE PAGES

Dooraghi, Alex A.; Carroll, Lewis; Collins, Jeffrey; ...

2016-03-09

Automated protocols for measuring and dispensing solutions containing radioisotopes are essential not only for providing a safe environment for radiation workers but also to ensure accuracy of dispensed radioactivity and an efficient workflow. For this purpose, we have designed ARAS, an automated radioactivity aliquoting system for dispensing solutions containing positron-emitting radioisotopes with particular focus on fluorine-18 (18F). The key to the system is the combination of a radiation detector measuring radioactivity concentration, in line with a peristaltic pump dispensing known volumes. Results show the combined system demonstrates volume variation to be within 5 % for dispensing volumes of 20 μLmore » or greater. When considering volumes of 20 μL or greater, the delivered radioactivity is in agreement with the requested amount as measured independently with a dose calibrator to within 2 % on average. In conclusion, the integration of the detector and pump in an in-line system leads to a flexible and compact approach that can accurately dispense solutions containing radioactivity concentrations ranging from the high values typical of [18F]fluoride directly produced from a cyclotron (~0.1-1 mCi μL -1) to the low values typical of batches of [18F]fluoride-labeled radiotracers intended for preclinical mouse scans (~1-10 μCi μL -1).« less

ELECTROSPUN MESOFIBERS, A NOVEL BIODEGRADABLE PHEROMONE DISPENSER TECHNOLOGY, ARE COMBINED WITH MECHANICAL DEPLOYMENT FOR EFFICIENT IPM OF LOBESIA BOTRANA IN VINEYARDS.

PubMed

Hummel, Hans E; Langner, S S; Breuer, M

2015-01-01

Behaviour modifying pheromones are well known agents for disrupting mating communication of pest insects. For optimal activity, they must be dispensed in time and space at a quantitatively measurable, predetermined release rate covering the flight period of the target species. Pheromones appeal to environmentally conscientious entomologists for their biodegradability, non-toxicity and ecological compatibility. In attempts of combining the virtues of pheromones, suitable slow release dispensers, and their mechanical deployment, an ecologically sensible, reasonably priced and patented procedure was developed and tested with the vineyard pest Lobesia botrana (Lep.: Tortricidae). It is characterized by (1) Electrospun mesofibers with diameters ranging from 0.6 to 3.5 micrometres, containing disruptants and dispensing it by slow release diffusion into the crop, (2) simultaneous application of the fully biodegradable combination of pheromone with Ecoflex polyester mesofiber, (3) combination of mechanical deployment by multi-purpose cultivators of the prefabricated pheromone dispensers with other simultaneous cultivation measures, and thus further reducing labour time and treatment costs. The dispensers are biodegradable within half a year without leaving any objectionable residues. In the standard eco-toxicology tests pheromone dispensers are harmless to non-target organisms. The disruptive effect of one treatment lasts for seven weeks which covers well one of several flight periods of L. botrana.

Keeping the "continuous" in continuous quality improvement: exploring perceived outcomes of CQI program use in community pharmacy.

PubMed

Boyle, Todd A; Bishop, Andrea C; Duggan, Kellie; Reid, Carolyn; Mahaffey, Thomas; MacKinnon, Neil J; Mahaffey, Amelia

2014-01-01

Given the significant potential of continuous quality improvement (CQI) programs in enhancing overall levels of patient safety, community pharmacies in North America are under increasing pressure to have a formal and documented CQI program in place. However, while such initiatives may seem great on paper, in practice the outcomes of such programs to community pharmacy practice remain unclear. To explore the perceived outcomes identified by community pharmacies that adopted and actively used a standardized (i.e., common across pharmacies) CQI program for at least 1 year and to develop a framework for how such outcomes were achieved. A multi-site study of SafetyNET-Rx, a standardized and technologically sophisticated (e.g., online reporting of medication errors to a national database) CQI program, involving community pharmacies in Nova Scotia, Canada, was performed. During the summer and fall of 2011, 22 interviews were conducted with the CQI facilitators in 12 Nova Scotia community pharmacies; equally split between independent/banners and corporate chains. Of the CQI facilitators, 14 were pharmacists, while the remaining eight were pharmacy technicians. Thematic analysis following the procedures presented by Braun and Clarke was adopted to identify and explore the major outcomes. Results of the thematic analysis highlighted a number of perceived outcomes from the use of a standardized CQI program in community pharmacies, specifically: (1) perceived reduction in the number of medication errors that were occurring in the pharmacy, (2) increased awareness/confidence of individual actions related to dispensing, (3) increased understanding of the dispensing and related processes/workflow, (4) increased openness to talking about medication errors among pharmacy staff, and (5) quality and safety becoming more entrenched in the workflow (e.g., staff is more aware of their roles and responsibilities in patient safety and confident that the dispensing processes are safe and reliable). In achieving such outcomes, pharmacies had to balance customizing the CQI program to address a number of operational challenges, with ensuring that the core standardized components remained in place. This research identified the perceived outcomes of CQI program use by CQI facilitators. Additionally, the findings are incorporated into a framework for CQI implementation that can be used by pharmacy managers, corporate head offices, and regulatory authorities to leverage greater CQI adoption and success. Copyright © 2014 Elsevier Inc. All rights reserved.

Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial

PubMed Central

Celum, Connie; Wald, Anna; Hughes, James; Sanchez, Jorge; Reid, Stewart; Delany-Moretlwe, Sinead; Cowan, Frances; Casapia, Martin; Ortiz, Abner; Fuchs, Jonathan; Buchbinder, Susan; Koblin, Beryl; Zwerski, Sheryl; Rose, Scott; Wang, Jing; Corey, Lawrence

2009-01-01

Summary Background Across many observational studies, herpes simplex virus type 2 (HSV-2) infection is associated with two-fold to three-fold increased risk for HIV-1 infection. We investigated whether HSV-2 suppression with aciclovir would reduce the risk of HIV-1 acquisition. Methods We undertook a double-blind, randomised, placebo-controlled phase III trial in HIV-negative, HSV-2 seropositive women in Africa and men who have sex with men (MSM) from sites in Peru and the USA. Participants were randomly assigned by block randomisation to twice daily aciclovir 400 mg (n=1637) or matching placebo (n=1640) for 12–18 months, and were seen monthly for dispensation of study drug, adherence counselling and measurement by pill count and self-reporting, and risk reduction counselling, and every 3 months for genital examination and HIV testing. The primary outcome was HIV-1 acquisition and secondary was incidence of genital ulcers. Analysis was by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00076232. Findings 3172 participants (1358 women, 1814 MSM) were included in the primary dataset (1581 in aciclovir group, 1591 in control group). The incidence of HIV-1 was 3.9 per 100 person-years in the aciclovir group (75 events in 1935 person-years of follow-up) and 3.3 per 100 person-years in the placebo group (64 events in 1969 person-years of follow-up; hazard ratio 1.16 [95% CI 0.83–1.62]). Incidence of genital ulcers on examination was reduced by 47% (relative risk 0.53 [0.46–0.62]) and HSV-2 positive genital ulcers by 63% (0.37 [0.31–0.45]) in the aciclovir group. Adherence to dispensed study drug was 94% in the aciclovir group and 94% in the placebo group, and 85% of expected doses in the aciclovir group and 86% in the placebo group. Retention was 85% at 18 months in both groups (1028 of 1212 in aciclovir group, 1030 of 1208 in placebo group). We recorded no serious events related to the study drug. Interpretation Our results show that suppressive therapy with standard doses of aciclovir is not effective in reduction of HIV-1 acquisition in HSV-2 seropositive women and MSM. Novel strategies are needed to interrupt interactions between HSV-2 and HIV-1. Funding US National Institute of Allergy and Infectious Diseases, US National Institute of Child Health and Human Development, US National Institute of Drug Abuse, US National Institute of Mental Health, US Office of AIDS Research, and GlaxoSmithKline. PMID:18572080

First-line medications for alcohol use disorders among public drug plan beneficiaries in Ontario.

PubMed

Spithoff, Sheryl; Turner, Suzanne; Gomes, Tara; Martins, Diana; Singh, Samantha

2017-05-01

To examine use of first-line alcohol use disorder (AUD) medications (naltrexone and acamprosate) among public drug plan beneficiaries in the year following an AUD diagnosis. Retrospective population-based cohort study. Ontario. Individuals eligible for public drug plan benefits who had an AUD diagnosis at a hospital visit between April 1, 2011, and March 31, 2012. Number of AUD medications dispensed to public drug plan beneficiaries who had a recent hospital visit with an AUD diagnosis, and number of prescriptions dispensed per person. A total of 10 394 Ontarians between 18 and 65 years of age were identified who had a hospital visit with an AUD diagnosis and were eligible for public drug plan benefits. The rate of AUD medications dispensed in the subsequent year was 3.56 per 1000 population (95% CI 2.51 to 4.91; n = 37). This rate did not differ significantly by sex ( P = .83). Very few public drug plan beneficiaries are dispensed first-line AUD medications in the year following an AUD diagnosis. Copyright© the College of Family Physicians of Canada.

Use of direct washing of chemical dispense nozzle for defect control

NASA Astrophysics Data System (ADS)

Linnane, Michael; Mack, George; Longstaff, Christopher; Winter, Thomas

2006-03-01

Demands for continued defect reduction in 300mm IC manufacturing are driving process engineers to examine all aspects of the chemical apply process for improvement. Historically, the defect contribution from photoresist apply nozzles has been minimized through a carefully controlled process of "dummy dispenses" to keep the photoresist in the tip "fresh" and remove any solidified material, a preventive maintenance regime involving periodic cleaning or replacing of the nozzles, and reliance on a pool of solvent within the nozzle storage block to keep the photoresist from solidifying at the nozzle tip. The industry standard has worked well for the most part but has limitations in terms of cost effectiveness and absolute defect elimination. In this study, we investigate the direct washing of the chemical apply nozzle to reduce defects seen on the coated wafer. Data is presented on how the direct washing of the chemical dispense nozzle can be used to reduce coating related defects, reduce material costs from the reduction of "dummy dispense", and can reduce equipment downtime related to nozzle cleaning or replacement.

Private pharmacy staff in Hanoi dispensing steroids - theory and practice

PubMed Central

Larsson, Mattias; Binh, Nguyen Thanh; Tomson, Göran; Chuc, Nguyen TK; Falkenberg, Torkel

Objective To investigate self reported practice and actual practice of private pharmacy staff in relation to drug regulations and provision of prednisolone (a prescription-only corticosteroid) on request to treat lower back pain. Method Sixty private pharmacies in Hanoi were randomly selected. Self reported practice was assessed through interviews with pharmacy staff using a questionnaire; actual practice was assessed with the Simulated Client Method with 5 encounters in each pharmacy (a total of 295 encounters). Results Sixty percent of the pharmacy staff interviewed said that they would not dispense corticosteroids without prescription and 60% could mention some adverse effects. In practice all but one pharmacy dispensed corticosteroids without prescription in 76 % of all the encounters. Questions and advice given to the clients were associated with significantly lower dispensing of corticosteroids. Conclusion The low compliance with prescription regulations and the discrepancy between stated practice and actual practice raises concerns. This study indicates that commercial pressures exceed the deterrent effect of current drug regulations and their implementation and hence enforcement of regulations needs to be improved. PMID:25247001

Label-free isolation and deposition of single bacterial cells from heterogeneous samples for clonal culturing

NASA Astrophysics Data System (ADS)

Riba, J.; Gleichmann, T.; Zimmermann, S.; Zengerle, R.; Koltay, P.

2016-09-01

The isolation and analysis of single prokaryotic cells down to 1 μm and less in size poses a special challenge and requires micro-engineered devices to handle volumes in the picoliter to nanoliter range. Here, an advanced Single-Cell Printer (SCP) was applied for automated and label-free isolation and deposition of bacterial cells encapsulated in 35 pl droplets by inkjet-like printing. To achieve this, dispenser chips to generate micro droplets have been fabricated with nozzles 20 μm in size. Further, the magnification of the optical system used for cell detection was increased. Redesign of the optical path allows for collision-free addressing of any flat substrate since no compartment protrudes below the nozzle of the dispenser chip anymore. The improved system allows for deterministic isolation of individual bacterial cells. A single-cell printing efficiency of 93% was obtained as shown by printing fluorescent labeled E. coli. A 96-well plate filled with growth medium is inoculated with single bacteria cells on average within about 8 min. Finally, individual bacterial cells from a heterogeneous sample of E. coli and E. faecalis were isolated for clonal culturing directly on agar plates in user-defined array geometry.

Effectiveness of an extended period of flashing lights and strategic signage to increase the salience of alcohol-gel dispensers for improving hand hygiene compliance.

PubMed

Rashidi, Babak; Li, Aimee; Patel, Rakesh; Harmsen, Irene E; Sabri, Elham; Kyeremanteng, Kwadwo; D'Egidio, Gianni

2016-07-01

Multiple factors affect compliance with hand hygiene, including conspicuity of alcohol-gel dispensers. Previous studies have shown that flashing lights increase hand hygiene compliance; however, the durability of this effect has not been studied. We affixed flashing lights to hand sanitizer dispensers for a total of 6 weeks. Regression analysis was used to compare compliance rates between the beginning and end of the intervention. Our secondary objective was to determine whether compliance rates in cold weather could be improved by adding a sign separated in time and space from the dispensers. Flashing lights improved hand hygiene compliance from 11.8% to 20.7%, and this effect was unchanged over the 6-week study period. Fully charged lights resulted in a greater compliance increase. A preemptive sign did not have a significant effect on hand hygiene rates nor did absolute temperatures. Flashing lights are a simple, inexpensive way of improving hand hygiene. Brighter lights appear to have a greater effect; however, this must be balanced with annoyance in specific settings. Temperature did not have a significant effect; however, this may be because the relationship does not fit a linear model. Other interventions, such as signs, may need to be tailored specifically to individual hospital environments. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

[Impact of an automated dispensing system for medical devices in cardiac surgery department].

PubMed

Clou, E; Dompnier, M; Kably, B; Leplay, C; Poupon, E; Archer, V; Paul, M

2018-01-01

To secure medical devices' management, the implementation of automated dispensing system in surgical service has been realized. The objective of this study was to evaluate security, organizational and economic impact of installing automated dispensing system for medical devices (ASDM). The implementation took place in a cardiac surgery department. Security impact was assessed by comparing traceability rate of implantable medical devices one year before and one year after installation. Questionnaire on nurses' perception and satisfaction completed this survey. Resupplying costs, stocks' evolution and investments for the implementation of ASDM were the subject of cost-benefit study. After one year, traceability rate is excellent (100%). Nursing staffs were satisfied with 87.5% by this new system. The introduction of ASDM allowed a qualitative and quantitative decrease in stocks, with a reduction of 30% for purchased medical devices and 15% for implantable medical devices in deposit-consignment. Cost-benefit analysis shows a rapid return on investment. Real stock decrease (purchased medical devices) is equivalent to 46.6% of investment. Implementation of ASDM allows to secure storage and dispensing of medical devices. This system has also an important economic impact and appreciated by users. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Examining the impacts of ethanol (E85) versus gasoline photochemical production of smog in a fog using near-explicit gas- and aqueous-chemistry mechanisms

NASA Astrophysics Data System (ADS)

Ginnebaugh, Diana L.; Jacobson, Mark Z.

2012-12-01

This study investigates the air quality impacts of using a high-blend ethanol fuel (E85) instead of gasoline in vehicles in an urban setting when a morning fog is present under summer and winter conditions. The model couples the near-explicit gas-phase Master Chemical Mechanism (MCM v. 3.1) with the extensive aqueous-phase Chemical Aqueous Phase Radical Mechanism (CAPRAM 3.0i) in SMVGEAR II, a fast and accurate ordinary differential equation solver. Summer and winter scenarios are investigated during a two day period in the South Coast Air Basin (SCAB) with all gasoline vehicles replaced by flex-fuel vehicles running on E85 in 2020. We find that E85 slightly increases ozone compared with gasoline in the presence or absence of a fog under summer conditions but increases ozone significantly relative to gasoline during winter conditions, although winter ozone is always lower than summer ozone. A new finding here is that a fog during summer may increase ozone after the fog disappears, due to chemistry alone. Temperatures were high enough in the summer to increase peroxy radical (RO2) production with the morning fog, which led to the higher ozone after fog dissipation. A fog on a winter day decreases ozone after the fog. Within a fog, ozone is always lower than if no fog occurs. The sensitivity of the results to fog parameters like droplet size, liquid water content, fog duration and photolysis are investigated and discussed. The results support previous work suggesting that E85 and gasoline both enhance pollution with E85 enhancing pollution significantly more at low temperatures. Thus, neither E85 nor gasoline is a ‘clean-burning’ fuel.

Assessing Public Preferences for Forest Biomass Based Energy in the Southern United States

NASA Astrophysics Data System (ADS)

Susaeta, Andres; Alavalapati, Janaki; Lal, Pankaj; Matta, Jagannadha R.; Mercer, Evan

2010-04-01

This article investigated public preferences for forest biomass based liquid biofuels, particularly ethanol blends of 10% ( E10) and 85% ( E85). We conducted a choice experiment study in three southern states in the United States: Arkansas, Florida, and Virginia. Reducing atmospheric CO2, decreasing risk of wildfires and pest outbreaks, and enhancing biodiversity were presented to respondents as attributes of using biofuels. Results indicated that individuals had a positive extra willingness to pay (WTP) for both ethanol blends. The extra WTP was greater for higher blends that offered larger environment benefits. The WTPs for E10 were 0.56 gallon-1, 0.58 gallon-1, and 0.48 gallon-1, and for E85 they were 0.82 gallon-1, 1.17 gallon-1, and 1.06 gallon-1 in Arkansas, Florida, and Virginia, respectively. Although differences in WTP for E10 were statistically insignificant among the three states, significant differences were found in the WTP for E85 between AR and FL and between AR and VA. Preferences for the environmental attributes appeared to be heterogeneous, as respondents’ were willing to pay a premium for E10 in all three states to facilitate the reduction of CO2 and the improvement of biodiversity but were not willing to pay more for E85 in order to enhance biodiversity.

The sustainability of a community pharmacy intervention to improve the quality use of asthma medication.

PubMed

Bereznicki, B; Peterson, G; Jackson, S; Walters, E H; Gee, P

2011-04-01

A previously published asthma intervention used a software application to data mine pharmacy dispensing records and generate a list of patients with potentially suboptimal management of their asthma; in particular, a high rate of provision of reliever medication. These patients were sent educational material from their community pharmacists and advised to seek a review of their asthma management from their general practitioner. The intervention resulted in a 3-fold improvement in the ratio of dispensed preventer medication (inhaled corticosteroids) to reliever medication (short-acting beta-2 agonists). This follow-up study aimed to determine the long-term effects of the intervention programme on the preventer-to-reliever (P:R) ratio. The same data mining software was modified so that it could re-identify patients who were originally targeted for the intervention. Community pharmacists who participated in the previous intervention installed the modified version of the software. The dispensing data were then de-identified, encrypted and transferred via the Internet to a secure server. The follow-up dispensing data for all patients were compared with their pre- and post-intervention data collected originally. Of the 1551 patients who were included in the original study, 718 (46·3%) were eligible to be included in the follow-up study. The improved P:R ratio was sustained for at least 12 months following the intervention (P < 0·01). The sustained increase in the P:R ratio was attributed to significant decreases in the average daily usage of reliever medication (P < 0·0001). The follow-up study demonstrated a sustained improvement in the ratio of dispensed preventer medication to reliever medication for asthma. The intervention has the potential to show long-lasting and widespread improvements in asthma management, improved health outcomes for patients, and ultimately, a reduced burden on the health system. © 2010 Blackwell Publishing Ltd.

78 FR 62678 - Morris W. Cochran, M.D.; Decision and Order

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... States or the jurisdiction in which he practices or does research, to distribute, dispense, conduct... as to why his request was rejected. See 5 U.S.C. 555(e) (``Prompt notice shall be given of the denial... made in connections with any agency proceedings. Except in affirming a prior denial or when the denial...

A Method for Dispensing Planaria (Dugesia dorotocephala) for Mosquito Control

DTIC Science & Technology

1988-12-01

Predation of mosquitoes by the planarian Du- fed 20 fourth instar Aedes aei,3pa fLinn.) per ..esia dorotocephala (Woodworth) (Tricladida: planarian every...the planarian . Du4(.sa dfr,r,i,#- phala I\\Woodworthi. in the presence of (’ul,,x pcu., l.egner. E. F. and R. A. Medved. 1972. Predators Speiser

14 CFR 135.91 - Oxygen for medical use by passengers.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Oxygen for medical use by passengers. 135... Operations § 135.91 Oxygen for medical use by passengers. (a) Except as provided in paragraphs (d) and (e) of..., generation or dispensing of medical oxygen unless the unit to be carried is constructed so that all valves...

14 CFR 135.91 - Oxygen for medical use by passengers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Oxygen for medical use by passengers. 135... Operations § 135.91 Oxygen for medical use by passengers. (a) Except as provided in paragraphs (d) and (e) of..., generation or dispensing of medical oxygen unless the unit to be carried is constructed so that all valves...

14 CFR 135.91 - Oxygen for medical use by passengers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Oxygen for medical use by passengers. 135... Operations § 135.91 Oxygen for medical use by passengers. (a) Except as provided in paragraphs (d) and (e) of..., generation or dispensing of medical oxygen unless the unit to be carried is constructed so that all valves...

14 CFR 135.91 - Oxygen for medical use by passengers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Oxygen for medical use by passengers. 135... Operations § 135.91 Oxygen for medical use by passengers. (a) Except as provided in paragraphs (d) and (e) of..., generation or dispensing of medical oxygen unless the unit to be carried is constructed so that all valves...

14 CFR 135.91 - Oxygen for medical use by passengers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Oxygen for medical use by passengers. 135... Operations § 135.91 Oxygen for medical use by passengers. (a) Except as provided in paragraphs (d) and (e) of..., generation or dispensing of medical oxygen unless the unit to be carried is constructed so that all valves...

Suppression of mediterranean fruit fly(Diptera: Tephritidae) with trimedlure(TML) dispensers and biolure in coffee(Coffea arabica L)

USDA-ARS?s Scientific Manuscript database

Solid Trimedlure[TML] dispensers and novel solid triple lure dispensers[TMR] without insecticides were tested as “attract and kill” devices alone and in combination with Biolure mass trapping to evaluate suppression of Mediterranean fruit fly, Ceratitis capitata(Wiedemann) in a large coffee plantati...

48 CFR 52.237-11 - Accepting and Dispensing of $1 Coin.

Code of Federal Regulations, 2011 CFR

2011-10-01

... of $1 Coin. 52.237-11 Section 52.237-11 Federal Acquisition Regulations System FEDERAL ACQUISITION... Clauses 52.237-11 Accepting and Dispensing of $1 Coin. As prescribed in 37.116-2, insert the following clause: Accepting and Dispensing of $1 Coin (SEP 2008) (a) This clause applies to service contracts that...

48 CFR 52.237-11 - Accepting and Dispensing of $1 Coin.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of $1 Coin. 52.237-11 Section 52.237-11 Federal Acquisition Regulations System FEDERAL ACQUISITION... Clauses 52.237-11 Accepting and Dispensing of $1 Coin. As prescribed in 37.116-2, insert the following clause: Accepting and Dispensing of $1 Coin (SEP 2008) (a) This clause applies to service contracts that...

40 CFR Table 1 to Subpart Cccccc... - Applicability Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000 Gallons of Gasoline or More1... CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants for Source Category: Gasoline... Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000...

40 CFR Table 1 to Subpart Cccccc... - Applicability Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000 Gallons of Gasoline or More1... CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants for Source Category: Gasoline... Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000...

40 CFR Table 1 to Subpart Cccccc... - Applicability Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000 Gallons of Gasoline or More1... CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants for Source Category: Gasoline... Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000...

40 CFR Table 1 to Subpart Cccccc... - Applicability Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000 Gallons of Gasoline or More1... CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants for Source Category: Gasoline... Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly Throughput of 100,000...

21 CFR 1301.27 - Separate registration by retail pharmacies for installation and operation of automated dispensing...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Separate registration by retail pharmacies for....27 Separate registration by retail pharmacies for installation and operation of automated dispensing systems at long term care facilities. (a) A retail pharmacy may install and operate automated dispensing...

21 CFR 1301.27 - Separate registration by retail pharmacies for installation and operation of automated dispensing...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Separate registration by retail pharmacies for....27 Separate registration by retail pharmacies for installation and operation of automated dispensing systems at long term care facilities. (a) A retail pharmacy may install and operate automated dispensing...

21 CFR 1301.27 - Separate registration by retail pharmacies for installation and operation of automated dispensing...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Separate registration by retail pharmacies for....27 Separate registration by retail pharmacies for installation and operation of automated dispensing systems at long term care facilities. (a) A retail pharmacy may install and operate automated dispensing...

21 CFR 1301.27 - Separate registration by retail pharmacies for installation and operation of automated dispensing...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Separate registration by retail pharmacies for....27 Separate registration by retail pharmacies for installation and operation of automated dispensing systems at long term care facilities. (a) A retail pharmacy may install and operate automated dispensing...

21 CFR 1301.27 - Separate registration by retail pharmacies for installation and operation of automated dispensing...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Separate registration by retail pharmacies for....27 Separate registration by retail pharmacies for installation and operation of automated dispensing systems at long term care facilities. (a) A retail pharmacy may install and operate automated dispensing...

40 CFR 86.146-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

40 CFR 86.146-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

40 CFR 86.1246-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

40 CFR 86.1246-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

Task Analysis in Optical & Contact Lens Dispensing. Dispensing Opticians.

ERIC Educational Resources Information Center

Hrushowy, Eugene; Stanley, Dale

A task force of opticians and educators in British Columbia was assembled to determine the knowledge and skills required of dispensing opticians and contact lens specialists. The ideas generated by the task force were analyzed and distilled into the standardized tasks listed in this document, using Krathwohl's taxonomy. The document contains 36…

Cable-Dispensing Cart

NASA Technical Reports Server (NTRS)

Bredberg, Alan S.

2003-01-01

A versatile cable-dispensing cart can support as many as a few dozen reels of cable, wire, and/or rope. The cart can be adjusted to accommodate reels of various diameters and widths, and can be expanded, contracted, or otherwise reconfigured by use of easily installable and removable parts that can be carried onboard. Among these parts are dispensing rods and a cable guide that enables dispensing of cables without affecting the direction of pull. Individual reels can be mounted on or removed from the cart without affecting the other reels: this feature facilitates the replacement or reuse of partially depleted reels, thereby helping to reduce waste. Multiple cables, wires, or ropes can be dispensed simultaneously. For maneuverability, the cart is mounted on three wheels. Once it has been positioned, the cart is supported by rubber mounts for stability and for prevention of sliding or rolling during dispensing operations. The stability and safety of the cart are enhanced by a low-center-of-gravity design. The cart can readily be disassembled into smaller units for storage or shipping, then reassembled in the desired configuration at a job site.

Optimizing Aerosol Dispensers for Mating Disruption of Codling Moth, Cydia pomonella L.

PubMed

McGhee, Peter S; Miller, James R; Thomson, Donald R; Gut, Larry J

2016-07-01

Experiments were conducted in commercial apple orchards to determine if improved efficiencies in pheromone delivery may be realized by using aerosol pheromone dispensers for codling moth (CM), Cydia pomonella L., mating disruption. Specifically, we tested how reducing: pheromone concentration, period of dispenser operation, and frequency of pheromone emission from aerosol dispensers affected orientational disruption of male CM to pheromone-baited monitoring traps. Isomate® CM MIST formulated with 50 % less codlemone (3.5 mg/ emission) provided orientation disruption equal to the standard commercial formulation (7 mg / emission). Decreased periods of dispenser operation (3 and 6 h) and frequency of pheromone emission (30 and 60 min) provided a level of orientational disruption similar to the current standard protocol of releasing pheromone over a 12 h period on a 15 min cycle, respectively. These three modifications provide a means of substantially reducing the amount of pheromone necessary for CM disruption. The savings accompanying pheromone conservation could lead to increased adoption of CM mating disruption and, moreover, provide an opportunity for achieving higher levels of disruption by increasing dispenser densities.

Negatively-charged residues in the polar carboxy-terminal region in FSP27 are indispensable for expanding lipid droplets.

PubMed

Tamori, Yoshikazu; Tateya, Sanshiro; Ijuin, Takeshi; Nishimoto, Yuki; Nakajima, Shinsuke; Ogawa, Wataru

2016-03-01

FSP27 has an important role in large lipid droplet (LD) formation because it exchanges lipids at the contact site between LDs. In the present study, we clarify that the amino-terminal domain of FSP27 (amino acids 1-130) is dispensable for LD enlargement, although it accelerates LD growth. LD expansion depends on the carboxy-terminal domain of FSP27 (amino acids 131-239). Especially, the negative charge of the acidic residues (D215, E218, E219 and E220) in the polar carboxy-terminal region (amino acids 202-239) is essential for the enlargement of LD. We propose that the carboxy-terminal domain of FSP27 has a crucial role in LD expansion, whereas the amino-terminal domain only has a supportive role. © 2016 Federation of European Biochemical Societies.

Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

PubMed

Doucette, William R; Kreling, David H; Schommer, Jon C; Gaither, Caroline A; Mott, David A; Pedersen, Craig A

2006-01-01

To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. Cross-sectional study. Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.

Community Pharmacy-Based Inducement Programs Associated With Better Medication Adherence: A Cohort Study.

PubMed

Simpson, Scot H; Lin, Mu; Eurich, Dean T

2017-08-01

Inducement programs can promote customer loyalty; however, the clinical effects of these programs are unknown. To examine relationships among inducement program use, medication adherence, and health outcomes. Alberta residents with ≥ 1 physician visit for diabetes or hypertension between April 2008 and March 2014 were eligible for this study and included if they were new statin users and alive at least 455 days after the first statin dispensation. Group assignment was based on whether all statin dispensations in the first year were obtained from pharmacies with or without inducement programs. Discontinuation was defined as no statin dispensations between 275 and 455 days after the first statin dispensation. Acute coronary syndrome (ACS) hospitalizations or deaths were identified between 456 days and 3 years after the first statin dispensation. Multivariable regression analyses were conducted to examine relationships among inducement program use, discontinuation, and ACS events. Among the 159 998 new statin users, mean age was 60.2 (±13.7) years and 67 534 (42%) were women. Statin discontinuation occurred in 22 455 (28.9%) of 77 803 inducement group participants and 25 816 (31.4%) of 82 195 noninducement group participants (adjusted odds ratio = 0.88; 95% CI = 0.86-0.90). Risk of an ACS event was similar between groups (adjusted hazard ratio = 1.00; 95% CI 0.92-1.08); however, discontinuing statin therapy was associated with a higher risk of an ACS event (adjusted hazard ratio = 1.27; 95% CI = 1.16-1.39). Inducement programs are associated with better adherence and not directly associated with risk of health outcomes.

Medication errors in outpatient care in Colombia, 2005-2013.

PubMed

Machado-Alba, Jorge E; Moncada, Juan Carlos; Moreno-Gutiérrez, Paula Andrea

2016-06-03

Medication errors outside the hospital have been poorly studied despite representing an important threat to patient safety. To describe the characteristics of medication errors in outpatient dispensing pharmacists reported in a pharmaco-surveillance system between 2005 and 2013 in Colombia. We conducted a descriptive study by reviewing and categorizing medication error reports from outpatient pharmacy services to a national medication dispensing company between January, 2005 and September, 2013. Variables considered included: process involved (administration, dispensing, prescription and transcription), wrong drug, time delay for the report, error type, cause and severity. The analysis was conducted in the SPSS® software, version 22.0. A total of 14,873 medication errors were reviewed, of which 67.2% in fact occurred, 15.5% reached the patient and 0.7% caused harm. Administration (OR=93.61, CI 95%: 48.510-180.655, p<0.001), dispensing (OR=21.58, CI 95%: 16.139-28.870, p<0.001), transcription errors (OR=5.64; CI 95%: 3.488-9.142, p<0.001), medicines for sensory organs (OR=2.04, CI 95%: 1.519-2.756, p<0.001), anti-infective drugs for systemic use (OR=1.99, CI 95%: 1.574-2.525, p0.001), confusion generated with the name of the drug (OR=1.28, CI 95%: 1.051-1.560, p=0.014), and trouble interpreting prescriptions (OR=1.32, CI 95%: 1.037-1.702, p=0.025) increased the risk for error reaching the patient. It is necessary to develop surveillance systems for medication errors in ambulatory care, focusing on the prescription, transcription and dispensation processes. Special strategies are needed for the prevention of medication errors related to anti-infective drugs.

Improving investigational drug service operations through development of an innovative computer system.

PubMed

Sweet, Burgunda V; Tamer, Helen R; Siden, Rivka; McCreadie, Scott R; McGregory, Michael E; Benner, Todd; Tankanow, Roberta M

2008-05-15

The development of a computerized system for protocol management, dispensing, inventory accountability, and billing by the investigational drug service (IDS) of a university health system is described. After an unsuccessful search for a commercial system that would accommodate the variation among investigational protocols and meet regulatory requirements, the IDS worked with the health-system pharmacy's information technology staff and informatics pharmacists to develop its own system. The informatics pharmacists observed work-flow and information capture in the IDS and identified opportunities for improved efficiency with an automated system. An iterative build-test-design process was used to provide the flexibility needed for individual protocols. The intent was to design a system that would support most IDS processes, using components that would allow automated backup and redundancies. A browser-based system was chosen to allow remote access. Servers, bar-code scanners, and printers were integrated into the final system design. Initial implementation involved 10 investigational protocols chosen on the basis of dispensing volume and complexity of study design. Other protocols were added over a two-year period; all studies whose drugs were dispensed from the IDS were added, followed by those for which the drugs were dispensed from decentralized pharmacy areas. The IDS briefly used temporary staff to free pharmacist and technician time for system implementation. Decentralized pharmacy areas that rarely dispense investigational drugs continue to use manual processes, with subsequent data transcription into the system. Through the university's technology transfer division, the system was licensed by an external company for sale to other IDSs. The WebIDS system has improved daily operations, enhanced safety and efficiency, and helped meet regulatory requirements for investigational drugs.

Iodine generator for reclaimed water purification

NASA Technical Reports Server (NTRS)

Wynveen, R. A.; Powell, J. D.; Schubert, F. H. (Inventor)

1977-01-01

The system disclosed is for controlling the iodine level in a water supply in a spacecraft. It includes an iodine accumulator which stores crystalline iodine, an electrochemical valve to control the input of iodine to the drinking water and an iodine dispenser. A pump dispenses fluid through the iodine dispenser and an iodine sensor to a potable water tank storage. The iodine sensor electronically detects the iodine level in the water, and through electronic means, produces a correction current control. The correction current control operates the electro-chemical iodine valve to release iodine from the iodine accumulator into the iodine dispenser.

Organisational and extraorganisational determinants of volume of service delivery by English community pharmacies: a cross-sectional survey and secondary data analysis.

PubMed

Hann, Mark; Schafheutle, Ellen I; Bradley, Fay; Elvey, Rebecca; Wagner, Andrew; Halsall, Devina; Hassell, Karen; Jacobs, Sally

2017-10-10

This study aimed to identify the organisational and extraorganisational factors associated with existing variation in the volume of services delivered by community pharmacies. Linear and ordered logistic regression of linked national data from secondary sources-community pharmacy activity, socioeconomic and health need datasets-and primary data from a questionnaire survey of community pharmacies in nine diverse geographical areas in England. Annual dispensing volume; annual volume of medicines use reviews (MURs). National dataset (n=10 454 pharmacies): greater dispensing volume was significantly associated with pharmacy ownership type (large chains>independents>supermarkets), greater deprivation, higher local prevalence of cardiovascular disease and depression, older people (aged >75 years) and infants (aged 0-4 years) but lower prevalence of mental health conditions. Greater volume of MURs was significantly associated with pharmacy ownership type (large chains/supermarkets>independents), greater dispensing volume, and lower disease prevalence.Survey dataset (n=285 pharmacies; response=34.6%): greater dispensing volume was significantly associated with staffing, skill-mix, organisational culture, years open and greater deprivation. Greater MUR volume was significantly associated with pharmacy ownership type (large chains/supermarkets>independents), greater dispensing volume, weekly opening hours and lower asthma prevalence. Organisational and extraorganisational factors were found to impact differently on dispensing volume and MUR activity, the latter being driven more by corporate ownership than population need. While levels of staffing and skill-mix were associated with dispensing volume, they did not influence MUR activity. Despite recent changes to the contractual framework, the existing fee-for-service reimbursement may therefore not be the most appropriate for the delivery of cognitive (rather than supply) services, still appearing to incentivise quantity over the quality (in terms of appropriate targeting) of services delivered. Future research should focus on the development of quality measures that could be incorporated into community pharmacy reimbursement mechanisms. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Separation of prescribing and dispensing in Malaysia: the history and challenges.

PubMed

Tiong, John Jeh Lung; Mai, Chun Wai; Gan, Pou Wee; Johnson, James; Mak, Vivienne Sook Li

2016-08-01

This article serves as an update to the work by Shafie et al. (2012) which previously reviewed the benefits of policies separating prescribing and dispensing in various countries to advocate its implementation in Malaysia. This article seeks to strengthen the argument by highlighting not only the weaknesses of the Malaysian health care system from the historical, professional and economic viewpoints but also the shortcomings of both medical and pharmacy professions in the absence of separation of dispensing. It also provides a detailed insight into the ongoing initiatives taken to consolidate the role of pharmacists in the health care system in the advent of separation of dispensing. Under the two tier system in Malaysia at present, the separation of prescribing and dispensing is implemented only in government hospitals. The absence of this separation in the private practices has led to possible profit-oriented medical and pharmacy practices which hinder safe and cost-effective delivery of health services. The call for separation of dispensing has gained traction over the years despite various hurdles ranging from the formidable resistance from the medical fraternity to the public's scepticism towards the new policy. With historical testament and present evidence pointing towards the merits of a system in which doctors prescribe and pharmacists dispense, the implementation of this health care model is justified. © 2016 The Authors. IJPP © 2016 Royal Pharmaceutical Society.

Alternative Fuels Data Center: Underwriters Laboratories Ethanol Dispenser

Science.gov Websites

alternate equivalent dispenser design to be submitted for approval. Each jurisdiction has its own process grant a waiver or variance on a case-by-case basis for alternative equivalent dispensers for mid- to procedures used to evaluate the product. The group of manufacturers and industry partners interested in

78 FR 21542 - Revisions to the California State Implementation Plan, Santa Barbara County Air Pollution Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

... water heaters, and the transfer and dispensing of gasoline. We are approving local rules that regulate... Heaters. SCAQMD 461 Gasoline Transfer and 04/06/12 09/21/12 Dispensing. On March 13, 2012 and October 11... SCAQMD Rule 461 controls emissions from the transfer and dispensing of gasoline. EPA's technical support...

22 CFR 401.19 - Reducing or extending time and dispensing with statements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Reducing or extending time and dispensing with... RULES OF PROCEDURE Applications § 401.19 Reducing or extending time and dispensing with statements. In... Commission may reduce or extend the time for the presentation of any paper or the doing of any act required...

21 CFR 1304.50 - Disclosure requirements for Web sites of nonpharmacy practitioners that dispense controlled...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Disclosure requirements for Web sites of nonpharmacy practitioners that dispense controlled substances by means of the Internet. 1304.50 Section 1304... that dispense controlled substances by means of the Internet. For a Web site to identify itself as...

21 CFR 1304.50 - Disclosure requirements for Web sites of nonpharmacy practitioners that dispense controlled...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Disclosure requirements for Web sites of nonpharmacy practitioners that dispense controlled substances by means of the Internet. 1304.50 Section 1304... that dispense controlled substances by means of the Internet. For a Web site to identify itself as...

Alternative Fuels Data Center: Blender Pump Dispensers

Science.gov Websites

... Blender Pump Dispensers Updated April 2, 2012 Federal and local initiatives to increase the use of ethanol choose the blend of fuel they want to use based on price, their vehicle's fuel economy, and other factors blends of those two fuels. Many conventional stations today use blender pump dispensers to generate

Flight response ofHeliothis subflexa (Gn.) females (Lepidoptera: Noctuidae) to an attractant from groundcherry,Physalis angulata L.

PubMed

Tingle, F C; Heath, R R; Mitchell, E R

1989-01-01

Mated femaleHeliothis subflexa (Gn.) (HS) moths 1-7 days old responded positively in a Plexiglas flight tunnel to an attractant extracted with methanol from fresh whole-leaf washes of groundcherry,Physalis angulata L. Response to the groundcherry extract, as indicated by plume-tracking (i.e., upwind flight toward the odor source) and contact with the chemical dispenser did not change significantly during the first 5 hr of scotophase. Overall, ca. 50% of the responding moths also landed on the chemical dispenser; ca. 50% of the moths that landed also deposited eggs. There were no significant differences in the behavioral responses of females mating only once and those that had mated two or more times. Virgin females and male moths were significantly less responsive to the groundcherry attractant than mated females. The flight tunnel bioassay described provides an excellent system for evaluating plant allelochemics associated with host-plant selection.

Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs.

PubMed

Krigsman, Kristin; Melander, Arne; Carlsten, Anders; Ekedahl, Anders; Nilsson, J Lars

2007-02-01

To determine the nature and extent of undersupply and the economic consequences of oversupply of medication among non-adherent patients. This study used copies of repeat prescriptions (= multiple dispensations), collected during 1 week in 2002 at 16 Swedish community pharmacies. For patients with a refill adherence below 80%, treatment gaps were defined as the number of days they had no drug available. The cost of drug oversupply (i.e., refill adherence > 120%) was calculated from the prices of the drug packages dispensed. The number of collected repeat prescriptions was 3,636. The median of treatment gaps among patients with a refill adherence below 80% was 53 days per 90-100 days treatment period and the corresponding median for oversupply was 40 days. The cost of oversupply for exempt patients (i.e., patients who have paid 1,800 SEK (Euro 196; US$ 243) per year for medicines) was 32,000 SEK (Euro 3,500; US$ 4,300) higher than for non-exempt patients. An extrapolation to all Sweden indicates that exemption from charges leads to an additional oversupply of about 142 million SEK (Euro 15 million; US$ 19 million) per year above that of non-exempt patients. Both undersupply and oversupply of prescribed medicines are common in Sweden. Patients with a refill adherence below 80% seem to have less than half of the prescribed treatment available. Oversupply or drug stockpiling occurs more frequently among exempt than among non-exempt patients, and this oversupply leads to high unnecessary costs.

Validating hospital antibiotic purchasing data as a metric of inpatient antibiotic use

PubMed Central

Tan, Charlie; Ritchie, Michael; Alldred, Jason; Daneman, Nick

2016-01-01

Objectives Antibiotic purchasing data are a widely used, but unsubstantiated, measure of antibiotic consumption. To validate this source, we compared purchasing data from hospitals and external medical databases with patient-level dispensing data. Methods Antibiotic purchasing and dispensing data from internal hospital records and purchasing data from IMS Health were obtained for two hospitals between May 2013 and April 2015. Internal purchasing data were validated against dispensing data, and IMS data were compared with both internal metrics. Scatterplots of individual antimicrobial data points were generated; Pearson's correlation and linear regression coefficients were computed. A secondary analysis re-examined these correlations over shorter calendar periods. Results Internal purchasing data were strongly correlated with dispensing data, with correlation coefficients of 0.90 (95% CI = 0.83–0.95) and 0.98 (95% CI = 0.95–0.99) at hospitals A and B, respectively. Although dispensing data were consistently lower than purchasing data, this was attributed to a single antibiotic at both hospitals. IMS data were favourably correlated with, but underestimated, internal purchasing and dispensing data. This difference was accounted for by eight antibiotics for which direct sales from some manufacturers were not included in the IMS database. The correlation between purchasing and dispensing data was consistent across periods as short as 3 months, but not at monthly intervals. Conclusions Both internal and external antibiotic purchasing data are strongly correlated with dispensing data. If outliers are accounted for appropriately, internal purchasing data could be used for cost-effective evaluation of antimicrobial stewardship programmes, and external data sets could be used for surveillance and research across geographical regions. PMID:26546668

[Design and piloting of a structured service medication dispensing process].

PubMed

Abaurre, Raquel; García-Delgado, Pilar; Maurandi, M Dolores; Arrebola, Cristóbal; Gastelurrutia, Miguel Ángel; Martínez-Martínez, Fernando

2015-01-01

The aim of this article is to design and pilot a protocol for the dispensing of medications service. Using the requirements proposed in the Ministry of Health Pharmaceutical Care Consensus, a literature search was made applying qualitative consensus techniques. An observational, cross-sectional study was conducted from March to June 2009. A total of 53 community pharmacies from 24 Spanish counties. Patients who requested one or more particular medications with or without medical prescription for their own use or for someone in their care. The personalised medication information (IPM), the problems associated with the medications (PRM), and the negative results associated with the medication (RNM), detected by the pharmacist each time medication was dispensed, as well as the perception of the pharmacist on the operability of the protocol were recorded. A total of 870 medications were dispensed, with 423 (48.6%) cases of lack of personalised medication information (IPM) being detected. PRM were detected in 10.11% of the dispensed medications, as well as 68 (7.81%) suspected RNM: safety (n = 35; 51.5%), effectiveness (n = 29; 42.6%) and necessity (n = 4; 5.8%). Almost two-thirds (65.21%) of the pharmacists said that the protocol is in operation. The designed protocol helped to detect deficiencies in the information to the patients about their medications, as well as the PRM and RNM, and is shown to be tool that is easy to use and apply. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Validation of a proxy for estrogen receptor status in breast cancer patients using dispensing data.

PubMed

Srasuebkul, Preeyaporn; Dobbins, Timothy A; Pearson, Sallie-Anne

2014-06-01

To assess the performance of a proxy for estrogen receptor (ER) status in breast cancer patients using dispensing data. We derived our proxy using 167 patients. ER+ patients had evidence of at least one dispensing record for hormone therapy during the lookback period, irrespective of diagnosis date and ER- had no dispensing records for hormone therapy during the period. We validated the proxy against our gold standard, ER status from pathology reports or medical records. We assessed the proxy's performance using three lookback periods: 4.5 years, 2 years, 1 year. More than half of our cohort (62%) were >50 years, 54% had stage III/IV breast cancer at recruitment, (46%) were diagnosed with breast cancer in 2009 and 23% were diagnosed before 2006. Sensitivity and specificity were high for the 4.5 year lookback period (93%, 95% CI: 86-96%; and 95%: 83-99%), respectively) and remained high for the 2-year lookback period (91%: 84-95%; and 95%: 83-99%). Sensitivity decreased (83%: 75.2-89%) but specificity remained high (95%: 83-99%) using the 1-year lookback period and the period is long enough to allow sufficient time for hormone therapy to be dispensed. Our proxy accurately infers ER status in studies of breast cancer treatment based on secondary health data. The proxy is most robust with a minimum lookback period of 2 years. © 2012 Wiley Publishing Asia Pty Ltd.

Organ-specific lymphangiectasia, arrested lymphatic sprouting, and maturation defects resulting from gene-targeting of the PI3K regulatory isoforms p85α, p55α, and p50α

PubMed Central

Mouta-Bellum, Carla; Kirov, Aleksander; Miceli-Libby, Laura; Mancini, Maria L.; Petrova, Tatiana V.; Liaw, Lucy; Prudovsky, Igor; Thorpe, Philip E.; Miura, Naoyuki; Cantley, Lewis C.; Alitalo, Kari; Fruman, David A.; Vary, Calvin P.H.

2010-01-01

The phosphoinositide 3-kinase (PI3K) family has multiple vascular functions, but the specific regulatory isoform supporting lymphangiogenesis remains unidentified. Here we report that deletion of the Pik3r1 gene, encoding the regulatory subunits p85α, p55α, and p50α impairs lymphatic sprouting and maturation, and causes abnormal lymphatic morphology, without major impact on blood vessels. Pik3r1 deletion had the most severe consequences among gut and diaphragm lymphatics, which share the retroperitoneal anlage, initially suggesting that the Pik3r1 role in this vasculature is anlage-dependent. However, whereas lymphatic sprouting toward the diaphragm was arrested, lymphatics invaded the gut, where remodeling and valve formation were impaired. Thus, cell-origin fails to explain the phenotype. Only the gut showed lymphangiectasia, lymphatic up-regulation of the TGFβ co-receptor endoglin, and reduced levels of mature VEGF-C protein. Our data suggest that Pik3r1 isoforms are required for distinct steps of embryonic lymphangiogenesis in different organ microenvironments, whereas they are largely dispensable for hemangiogenesis. PMID:19705443

Micromachined chemical jet dispenser

DOEpatents

Swierkowski, S.P.

1999-03-02

A dispenser is disclosed for chemical fluid samples that need to be precisely ejected in size, location, and time. The dispenser is a micro-electro-mechanical systems (MEMS) device fabricated in a bonded silicon wafer and a substrate, such as glass or silicon, using integrated circuit-like fabrication technology which is amenable to mass production. The dispensing is actuated by ultrasonic transducers that efficiently produce a pressure wave in capillaries that contain the chemicals. The 10-200 {micro}m diameter capillaries can be arranged to focus in one spot or may be arranged in a larger dense linear array (ca. 200 capillaries). The dispenser is analogous to some ink jet print heads for computer printers but the fluid is not heated, thus not damaging certain samples. Major applications are in biological sample handling and in analytical chemical procedures such as environmental sample analysis, medical lab analysis, or molecular biology chemistry experiments. 4 figs.