Search Results (250)

Many commercially available medications are often unapproved or unavailable in suitable dosage forms for specific patient populations, particularly infants and children. This necessitates the use of extemporaneously compounded formulations to deliver individualized doses based on body weight or body surface area, and when a medication is unavailable at an appropriate concentration or contains excipients potentially unsafe for certain patients. Extemporaneous compounding is required for oral liquids when patients are unable to swallow tablets or capsules. It is also needed for topical preparations and sterile dosage forms when commercial products are unavailable. Across regions, practices follow national pharmacopeial standards for both sterile and non-sterile compounding. Stability factors influencing the safety and efficacy of compounded formulations must be carefully considered when assigning appropriate beyond-use dates. While stability information is available for some medications in monographs, peer-reviewed literature, prescribing information, and investigator’s brochures, such data is often lacking for many compounded preparations. Emerging extemporaneous formulations—such as orodispersible films, nanoparticle systems, and 3D-printed compounds—offer potential advantages over traditional compounded formulations but present unique challenges to widespread implementation. Despite the justified clinical need for extemporaneous compounding, significant barriers remain, including limited access to medications, insufficient compounding expertise or resources, gaps in pharmacokinetic and safety data, and regulatory constraints. This review critically appraises the current state of extemporaneous compounding—drawing primarily on the United States of America frameworks—and highlights its continued necessity, associated challenges, and pragmatic solutions for advancing personalized pharmacotherapy across pediatric age groups worldwide. Full article

As of the end of 2024, the NIH-funded Research Centers in Minority Institutions (RCMI) Program supported 21 specialized centers at minority-serving institutions. Its goal is to strengthen biomedical research infrastructure and enhance the capacity of investigators focused on health disparities. Since 2017, the centers have operated under a unified framework that includes four core components, one of which is Community Engagement (CEC). In 2021, the RCMI Coordinating Center established the CEC consortium to unify expertise across minority-serving institutions, which include historically Black colleges and Hispanic-serving institutions. This consortium promotes cross-institutional collaboration and innovation in community-engaged research to advance health equity. This paper examines how RCMI CECs strategically enhance research relevance, advance public health outcomes, and address social determinants of health (SDOH) through inclusive, bidirectional partnerships that position communities as co-leaders in the research process. Drawing on data from NIH RePORTER, the 2024 Community Engagement Consortium Signature Programs Monograph, and RCMI Common Data Elements, we analyze the collective contributions of the Community Engagement Core (CECs) across 21 RCMI centers. Findings underscore the role of tailored strategies, cultural competence, and academic-community partnerships in mitigating health disparities and promoting equity in underserved communities. Full article

Background: The American Society of Clinical Oncology (ASCO) established recommendations for palliative care (PC), and they still remain the most trusted source overall. The standard published by C. Earle (defined in solid tumors) for referral to PC is > 55%. However, these rates remain unclear in general onco-hematology. Our referral rate reaches 60%; while it meets the standard, there are significant differences between ST and HM. Several authors have already pointed out these discrepancies. Arguing in some cases its possible relationship with the different behavior of professionals with different pathologies. Objective: The primary objective of this work is to understand the role that PC plays in onco-hematology and to determine the profile of patients referred to PC. Therefore, the article aims to establish some recommendations related to the results of prevalent characteristics. Methods: The Mortality Subcommittee (MS) includes and registers in a database all cancer patients who died in hospital undergoing systemic anticancer therapy (SACT) in their last 30 days of life (SACT ≤ 30 d). PC, in turn, works on relieving symptoms related to the disease and the patient. To understand the impact of PC in the MS database patients, we reviewed the literature for symptoms related to palliative care activity. Subsequently, we selected some signs and symptoms, by consensus with our PC specialists, in order to add them to the MS database and register them retrospectively. We measured the percentage of patients who registered these symptoms based on the data found in their electronic records. The results include the comparison by group: between patients referred or not to the PC program (PCP), and between the pathologies ST and HM. We used the programming language R (version 4.2) in our statistical analysis, including the “compareGroups” package (version 4.6), applying the pertinent tests based on the distribution of the data. Results: We completed the records on the 1681 patients from the period 2020–2023. 59.4% were men, the average age was 65.5 years, and 73.5% had ST and 26.5% had HM. Patients with lung cancer predominate (28.5%), with 71% of them being in the stage IV, followed by leukemia (9.76%). 60% are in progression of their disease, and 77% have advanced disease (AD). The average therapeutic aggressiveness indicators were SACT < 30 d: 38.9% (ST: 33.4%; HM: 70.97%); SACT < 14 d: 16.36% (ST: 13.76%; HM: 31.56%); the change in therapeutic regimen was 22% (ST: 20.8%; HM: 25.1%). The referral rate to PCP was 59.7% (ST: 68.2% and HM: 36.3%). Late referral (PCP ≤3 days before death) occurred in 29.2% of all patients, being 29% for ST cases and 30.4% for HM cases. Regarding the recording of signs and symptoms: psycho-emotional and analgesia regimens (including opioids) are better recorded in the PCP group (p < 0.001); the more physical symptoms (dyspnea, bleeding, infections, and severe symptoms) do not present statistically significant differences, although the severe symptoms in the PCP group are more disabling (cerebral involvement, spinal cord compression, vertebral crushing). The number of bags of blood products transfused is significantly lower in the PCP group (average 6.9 vs. 12.7). The total number of symptom variables with significant statistical differences was 13 for ST and 8 for HM. Conclusions: In this cohort, patients visited by PC had a better record of psycho-emotional symptoms. We consider that patients who are in any of the following situations should be referred to PC: initial diagnosis of stage IV lung cancer, leukemia; patients with advanced disease; presence of pain requiring opioids; psychoemotional symptoms; need for >7 to 15 transfusions of blood products and, if there are disabling symptoms. PC improves professional interest in the psycho-emotional and fragility situation of these patients. According to our data (in terms of the number of variables with significant differences by pathology group), we observed that hematologists tend to take on palliative tasks more frequently than their oncologist peers, who delegate them to PC in order to have more time dedicated to their specific field. Full article

The poetic turn—a significant shift in the rhetorical and/or dramatic trajectory of a poem—is a considerably under-recognized aspect of poetry. Despite being a crucial element in the working of so many poems, no large-scale critical conversation on the turn, such as a monograph or a collection of essays, exists. Despite its supposed innovations, the criticism of and about hybrid poetry has done little to change this. While many accomplished poets, including a number of hybrid poets, are alert to the structural dynamics of their poems—that is, they are aware of and significantly engage turns in their work—hybrid poet Jorie Graham is relatively unique in that her poetics and poems foreground turns to an extent and in ways that few others do. Specifically, Graham tropes the turn so that it represents even as it enacts transformative power. Such troping is at work in much of Graham’s oeuvre; however, it reveals itself especially clearly in her most recent collection, To 2040, in which the turn itself becomes one more natural, if sublime, element that is being lost to the ravages of unremitting environmental degradation. In To 2040, the turn becomes a hopeless craning—“we feel our soul turn frantic/in us, craning this way and that”—a desperate gesture that is ultimately empty as it has no safe place to land, no alternative position on which to rest or from which to relaunch. This powerful, if frightening, trajectory in Graham’s work can be difficult to recognize, especially given hybridity’s continued missing of the turn, but it is important to see: doing so can help to recenter the turn in discussions about poetry while also leading to an improved comprehension of Graham’s prophetic, apocalyptic vision. Full article

The first monographic exhibition dedicated to Vittore Carpaccio (ca. 1460–1525) in the US, and the first outside of Italy, was hosted at the National Gallery of Art in Washington, DC, from 20 Nov 2022 to 23 February 2023 (from where it went to Venice). Building on the research of art historians and experts on Venice and the larger Mediterranean region in the early modern period, this paper examines Carpaccio’s depiction of various “Turks” in some of the large narrative painting cycles (teleri) commissioned by the devotional confraternities (scuole) in Renaissance Venice. While Carpaccio’s and the larger Venetian familiarity with Islam, including Turks, has been studied, this paper compares various female figures in the St. Stephen cycle with those in his St. George cycle, situating them in the larger historical context of the commissioning scuole (Scuola di Santo Stefano and Scuola di San Giorgio degli Schiavoni, respectively). While attempting to uncover the significance, if not the identities, of a few individuals who stand out from the crowd, this paper urges caution when attempting to discern social history from a painting, much as we take literary texts (particularly those written well before our own times) with a grain of salt. Full article

Background/Objectives: Hospital compounding is essential for the delivery of patient-tailored therapies—particularly for pediatric and oncology patients and other groups requiring precise dosing. Its role is expected to grow as, for instance, the UK MHRA’s new Guidance on Decentralised Manufacturing promotes alternative manufacturing pathways that integrate hospital preparation units. However, drug substances that remain stable in commercial oral formulations may undergo rapid degradation under alternative conditions (e.g., aqueous suspension, light exposure, or in the presence of specific excipients). Despite these risks, formulation strategies in hospital compounding often rely on empirical practices and lack structured guidance regarding stability, impurity control, and reproducibility. Methods: This study proposes a risk-based scientific framework for formulation design, integrating degradation profiling with predictive toxicology. Potential degradation pathways (hydrolytic, oxidative, and photolytic) are systematically identified through forced-degradation studies combined with ab initio modeling. These risks are translated into formulation strategies using a structured decision tree encompassing solvent selection, pH adjustment, excipient compatibility, and packaging considerations, even in the absence of a pharmacopeial monograph. The toxicological relevance of degradation products is evaluated using in silico approaches aligned with ICH M7 guidelines, thereby defining critical quality attributes (cQAs) and critical process parameters (CPPs). Results: The applicability of the framework is demonstrated through hospital compounding case studies, with further extension toward advanced applications such as semi-solid extrusion (SSE) 3D printing. Conclusions: By integrating mechanistic understanding of drug degradation into formulation planning, the proposed framework enhances the safety, reproducibility, and quality of compounded preparations. This approach reinforces Good Preparation Practices (GPPs) and is consistent with international quality-by-design (QbD) principles in the context of personalized medicine. Full article

This article analyzes the work of Fr. Elias Friedman, whose legacy of theological work on Jewish identity and Jewish conversion to Catholicism serves as the foundation of the Association of Hebrew Catholics, of which he is the founder. Friedman frames his work as a sensitive approach to Jewish identity and Catholic faith, but as this paper demonstrates, his work reveals a reiteration of some of the most entrenched and historically devastating tropes of Christian anti-Judaism, as well as racial antisemitism. This article presents three main arguments. First, it demonstrates that Friedman’s work evidences a theological anti-Judaism characteristic of Catholicism prior to the Second Vatican Council, which he maintained firmly even after the theological revision of Vatican II rejected such views; and furthermore, that his work also expresses an antisemitism that reflects the modern racial antisemitism adopted by the Nazi regime. Second, this article examines the positive reception of Friedman’s work, as evidenced not only in the revered position he holds within the Association for Hebrew Catholics, but also by the nihil obstat and imprimatur on both of Friedman’s monographs, that is, the official stamp of ecclesiastical approval within the Catholic Church, which declares that the work is “free of doctrinal and moral error.” It proposes that these factors evidence the uncritical reception of his work not only within the Association of Hebrew Catholics, but also on behalf of the institutional Catholic Church. Third, it raises the question of the extent to which Friedman’s identity as a Jewish convert to Catholicism is relevant in the analysis and reception of his work. It argues that his Jewish identity makes his concoction of religious anti-Judaism and racial antisemitism particularly potent, rendering anodyne even the most virulently antisemitic of his statements. Full article

Biographies of Max Wilson and Gunnar Jungner were published in 2017 and 2020. An in-depth appreciation of the Wilson and Jungner principles, and the publication they were presented in, ‘Principles and Practice of Screening for Disease’, published as nr. 34 in the Public Health Paper-series of the World Health Organisation (W.H.O), called PHP-34 hereafter, was not published as yet. Here an analysis is given of PHP-34 and the ten screening principles, focusing on three subjects. First, by careful analysis of PHP-34, the literature published in the peer reviewed scientific literature, and other sources, the historical background and origin of the ten principles is determined. Second, the precise composition of PHP-34 is described, as parts of the monograph were derived from other seminal works published between roughly 1950 and 1965. Third, it is determined what the contributions of both authors of the monograph were. Results together are discussed in relation to the time PHP-34 was conceptualized and the importance of PHP-34 and the ten principles in the current era. Results show that in the 15 years preceding the publication of PHP-34, many principles of screening were published by authors in the United States of America, a selection of which ended up in PHP-34. Secondly, about 33% of the 145 pages of PHP-34 are drawn from other publications and studies on screening. Thirdly, the case can be made that the actual writing of PHP-34 was done (almost) entirely by Wilson. Regardless, Wilson and Jungner to this day should be applauded for their work. It is a testimony to the value of PHP-34 that we are still reflecting upon, discussing and seeking to intelligently apply the screening principles almost 60 years after their original publication. Full article

The rising incidence of microplastics (MPs) is a possible health risk to humans. The present study aims to analyze the presence of MPs in intravenous (IV) infusions and compare MP concentrations from multiple brands. The IV solutions of 29 medical devices (IV-MDs) from seven brands commercialized in Ecuador, Spain, and Italy have been selected under specific consideration to carry out the study. The detection of MPs has been quite obvious in almost all of the samples from brands in the mentioned countries. MP concentrations ranged from 9 to 20 MPs/L in glass containers to 166–299 MPs/L in plastic bags, with the majority of fragments (63%) on fibres (37%) and more than 60% of particles less than 100 µm. Nine different types of MPs were identified in this study. High clinical risk was indicated by markings with >200 MPs/L. Nevertheless, the medium polymeric danger index (PHI) was 1.7. According to these outcomes, IV infusion is a direct exposure to MPs that may have harmful medical repercussions. It is imperative that MPs’ limitations be included in pharmacopoeic monographs and in vivo toxicological and epidemiological studies. The present study aims to analyze the presence of MPs in IV-MDs and compare MP concentrations from multiple IV-MD brands. Full article

Arceuthobium—the dwarf mistletoes—is a clearly defined genus of hemi-parasitic plants in the family Viscaceae. The genus occurs throughout much of the Northern Hemisphere; however, the greatest concentration of species and subspecies occurs within coniferous forests of western North America, where considerable research was executed in the mid-to-late 20th century to determine their geographic distributions, host specializations, and taxonomic boundaries. However, the last monograph of Arceuthobium presenting morphological, phenological, phylogenetic, and physiological information for N. American dwarf mistletoes was published in 1996, and since that time, no subsequent publications have presented taxonomic information for the present classification of N. American Arceuthobium. Thus, herein, we provide updated phylogenetic and taxonomic data for 44 taxa of Arceuthobium indigenous to N. America while simultaneously addressing knowledge gaps and suggesting future research to improve our understanding of these ecologically and economically important forest tree parasites. The present classification systems for and recent treatments of N. American Arceuthobium are also discussed. Full article

Interpretation of the New Testament (NT) in general and the Pauline corpus in particular still appears to be at a crossroads. Scholars continue to publish articles and monographs in binary opposition to one another. The terminology used to designate the overarching perspectives of these binary publications sharply contrasts a “traditional” perspective (Protestant in general, and Lutheran in particular) with a variously named “new” or “radical new” perspective. Most recently, beyond the imprecise “new” terminology, the non-traditional perspective is being referred to as the “post-supersessionist”, “nonsupersessionist”, or “within Judaism” perspective and is still strongly being contested. Historically speaking, these antithetical perspectives cannot both be completely correct. Arguably, then, the time has come to explore what the study of Kuhnian paradigms might reveal about this state of affairs in NT scholarship. Most important, in proffering a twofold hermeneutical way forward that is focused on better understanding the emic perspective of the texts that we interpret—to the extent humanly possible—it is hoped that we might become more keenly aware of the ethical implications of our paradigms, terminology, and exegesis for those who rely on our work for their understanding and appropriation of the Scriptures in their everyday living. Full article

In 1900, Francis Herbert Jennison’s book The Manufacture of Lake Pigments from Artificial Colours was published in London. In the early 20th century, the technical literature focussing on synthetic dyes mainly dealt with their use for dyeing. Conversely, the literature on lake pigment manufacture is less comprehensive, and Jennison’s publication was the first monograph on this topic. His book comprises descriptions of the dyes, substrates, and various methods for lake making. Practical examples complete the work: sixteen colour plates with original samples of lake pigments showcase the practical effect on colour of the different dyes and preparation methods. Herein, we present an overview of the context of Jennison’s research and delve into a selection of formulations. Green lake pigment plates were sampled and analysed by liquid chromatography coupled with spectroscopic and spectrometric detectors and by X-ray fluorescence spectroscopy to correlate the chemical composition with the recipes reported in the book. Seldom or no longer used and unexplored historical dyes were detected, along with polyphenolic compounds possibly used as precipitating agents in lake pigment formulations. Moreover, the examination of two different editions of the Jennison manuscript (i.e., the English and German books) revealed different chemical profiles corresponding to the same lake pigment formulation. This emphasizes the significance of Jennison’s book, confirming how understanding of early formulations is needed to elucidate the later ones. Full article

Medicinal products available on the market should be characterised by therapeutic efficacy, high quality, and safety for patients. They must either be sterile or comply with the appropriate pharmacopoeial microbiological purity requirements. Pharmacopoeial monographs related to microbiological tests of drug quality were also referenced. Despite stringent regulations governing pharmaceutical production, irregularities in the microbiological quality of drugs still occur. These are monitored by relevant agencies, which may order the recall of defective product batches from the market. However, in recent years, numerous cases of microbiological contamination in drugs and drug-related infections have been reported. Both isolated incidents and larger outbreaks or epidemics linked to contaminated medicines have been documented. Various microorganisms, including Gram-negative and Gram-positive bacteria, anaerobes, and yeast-like and mould fungi, have been identified in medicinal products or in patients affected by contaminated drugs. Ensuring the appropriate purity or sterility of pharmaceutical raw materials; maintaining cleanliness in the manufacturing environment, facilities, and equipment; and adhering to hygiene protocols and Good Manufacturing Practice regulations are essential for the production of safe and high-quality medicinal products. The aim of this study is to collect and compile information on the microbiological quality of drugs available on the market, with particular attention to identified irregularities, objectionable microorganisms isolated from medicinal products, and drug-related infections. Full article

Drug interactions (DIs) can alter the effects of medications or result in adverse reactions. This scoping review aimed to map the existing scientific evidence regarding the DI between penicillin and hormonal contraceptives in women. Following the PRISMA-ScR, we conducted electronic searches in the MEDLINE, Embase, Web of Science, and the Virtual Health Library databases from August 2023 to January 2024. Observational studies, monographs, dissertations, theses, and conference abstracts with adolescent, adult, and elderly women who were concurrently using hormonal contraceptives and penicillin were eligible. DIs were defined based on the signs/symptoms presented by the women and self-reported pregnancies. Of the 4023 records identified in the databases, nine studies, published between 1979 and 2021, were included. Variability was found among the studies in terms of sample size, data collection method, participant’s age, medication types, diagnostic approach used to confirm the pregnancy, and the author’s recommendation of the DI. It could therefore be concluded that while the literature suggests a DI between hormonal contraceptives and penicillin, the level of scientific evidence is still scarce. Additional research on systemic and population factors is essential to better understand this DI and its repercussions. Full article

The construction and operation of high dam projects at high altitudes have led to concerns about the effectiveness of flood discharge security predictions resulting from the greater flood discharge atomized rain caused by ambient pressure reduction. In this study, self-similar characteristics and variation in atomized raindrop size distributions are analyzed to understand the phenomenon of increased atomized rain intensity under low ambient pressure from a mesoscopic scale. The monographic experiments are characterized by a low ambient pressure range (0.66P₀–1.02P₀) and a high waterjet velocity range (13.89–15.74 m/s). When the ambient pressure decreases by 0.10P₀ (P₀ = 101.325 kPa) from the reference atmospheric pressure condition as the other conditions remain fixed, the total number concentration in a two-dimensional atomized raindrop spectrum (number/(54 cm²)) and the peak value of the individual three-dimensional number concentration (number/(m³·mm) increase, which can lead to the required industry standard protective level of atomized zones increasing by one level in some cases. In addition, the spectrum trend and typical particle size ranges of the atomized raindrop size distributions present self-similarity as the ambient pressure decreases. The above studies further confirm the effects of low-ambient pressure enhancement on flood discharge atomized rain intensity, which can provide a theoretical basis for the development of random splash simulation models characterized by low pressure for high-altitude hydropower stations. Full article