Therapeutic drug monitoring of cefepime with micellar electrokinetic capillary chromatography: Assay improvement, quality assurance, and impact on patient drug levels

The improvement and performance of a micellar electrokinetic capillary chromatography assay for cefepime in human serum and plasma with a 50 μm id fused-silica capillary elongated from 40 to 60 cm is reported. Sample preparation with dodecylsulfate protein precipitation at pH 4.5, the pH 9.1 separation medium and the applied voltage were as reported previously[16]. The change resulted in a significant lower current, higher resolution and increased detection time intervals. The performance of the assay with multi-level internal calibration was assessed with calibration and control samples. Quality assurance data of a two year period assessed under the new conditions demonstrated the robustness of the assay. In serum samples of patients who received both cefepime and sulfamethoxazole, cefepime could not be detected due to the inseparability of the two compounds. The presence of an interference can be recognized by an increased peak width (width > 0.2 min), the appearance of a shoulder or an unresolved double peak. The patient data gathered during a three year period reveal that introduction of therapeutic drug monitoring led to a 50% reduction of the median drug level. The data suggest that therapeutic drug monitoring can help to minimize the risk of major adverse reactions and to increase drug safety on an individual basis. This article is protected by copyright. All rights reserved.

Ohio River. Letter from the Secretary of War transmitting pursuant to section 1 of the River and harbor act approved January 21, 1927, and section 10 of the Flood control act approved May 15, 1928, a letter from the Chief of Engineers, United States Army, dated August 14, 1935, submitting a report, together with accompanying papers and illustrations, containing a general plan for the improvement of the Ohio River for the purposes of navigation and efficient development of its water power, the control of floods, and the needs of irrigation.

"Report of the Board of engineers for rivers and harbors": p. 7-19.

Failure data handbook for nuclear power facilities : a guide for the design, construction, and maintenance of nuclear power plants from a reliability improvement standpoint /

Photocopy.

Review report on Salem Church Reservoir, Rappahannock River, Virginia: water supply, salinity control, flood control, water quality control, recreation, hydroelectric power. Appendix.

Vols. 2 (Appendix) bound with main volume.

Federal workforce quality : measurement and improvement : a report to the U.S. Merit Systems Protection Board and the U.S. Office of Personnel Management.

Shipping list no.: 92-0508-P.

Address on the power and value of the Sunday school system in evangelizing heathen and re-constructing Christian communitys, by an improvement of the religion and morals, the education and literature, and the social, civil and political institutions of every people : and on the Southern enterprise of the American Sunday school union ; delivered in the Lutheran Church, City of Charleston, on Monday evening, March 17, 1834 /

Author's presentation copy.

A new history of the life and reign of the Czar Peter the Great, Emperor of all Russia, and father of his country : Giving an exact relation of I. His travels, studies, and personal fatigues, for the attaining of knowledge in civil and military affairs, and the improvement of his subjects. II. His introduction of arts and sciences, a naval force, and commerce with foreign nations; also his many reformations in church and state, the army, and the customs and manners of his people. III. His wars with the Swedes, Turks, Tartars and Persians; victories by sea and land; acquisitions of territory, and increase of power. IV. His regard to genius and merit, particularly in the instances of General Le Fort, Prince Menzikoff, and the Empress Catharine: and his severe justice on offenders, exemplified in the proceedings against the czarewitz, and others. /

By John Bancks.

Legal provision respecting the education and employment of children in factories, &c.; with examples of improvement in manufacturing districts. Education and labor; or, The influence of education on the quality and value of labor; and its connection with insanity and crime.

Microfilm. Ann Arbor, Mich., University Microfilms [n.d.] (American culture series, Reel 235.2)

Improvement in the quality of worklife and productivity : a joint venture between management and employees : final report /

Photocopy of: 1976 ed. Los Angeles : Human Interaction Research Institute.

Central Valley Project Improvement Act : hearings before the Subcommittee on Water and Power of the Committee on Energy and Natural Resources, United States Senate, One Hundred Second Congress, first session, on S. 484 ... Los Angeles, CA, March 18, 1991; Washington, DC, May 6, 1991; Sacramento, CA, May 30, 1991.

"San Francisco, CA, September 4, 1991"--Pt. 2.

Modern environmental improvement pathways for the coal power generation industry in Australia

In this work we assess the pathways for environmental improvement by the coal utilization industry for power generation in Australia. In terms of resources, our findings show that coal is a long term resource of concern as coal reserves are likely to last for the next 500 years or more. However, our analysis indicates that evaporation losses of water in power generation will approach 1000 Gl (gigalitres) per year, equivalent to a consumption of half of the Australian residential population. As Australia is the second driest continent on earth, water consumption by power generators is a resource of immediate concern with regards to sustainability. We also show that coal will continue to play a major role in energy generation in Australia and, hence, there is a need to employ new technologies that can minimize environmental impacts. The major technologies to reduce impacts to air, water and soils are addressed. Of major interest, there is a major potential for developing sequestration processes in Australia, in particular by enhanced coal bed methane (ECBM) recovery at the Bowen Basin, South Sydney Basin and Gunnedah Basin. Having said that, CO2 capture technologies require further development to support any sequestration processes in order to comply with the Kyoto Protocol. Current power generation cycles are thermodynamic limited, with 35-40% efficiencies. To move to a high efficiency cycle, it is required to change technologies of which integrated gasification combined cycle plus fuel cell is the most promising, with efficiencies expected to reach 60-65%. However, risks of moving towards an unproven technology means that power generators are likely to continue to use pulverized fuel technologies, aiming at incremental efficiency improvements (business as usual). As a big picture pathway, power generators are likely to play an increasing role in regional development; in particular EcoParks and reclaiming saline water for treatment as pressures to access fresh water supplies will significantly increase.

Environmental quality in residential areas : a social survey approach to improvement priorities

The research is concerned with the measurement of residents' evaluations of the environmental quality of residential areas. The research reflects the increased attention being given to residents' values in planning decisions affecting the residential environment. The work was undertaken in co-operation with a local authority which was in the process of revising its housing strategy, and in particular the priorities for improvement action. The study critically examines the existing evidence on environmental values and their relationship to the environment and points to a number of methodological and conceptual deficiencies. The research strategy developed on the basis of the research review was constrained by the need to keep any survey methods simple so that they could easily be repeated, when necessary, by the sponsoring authority. A basic perception model was assumed, and a social survey carried out to measure residents' responses to different environmental conditions. The data was only assumed to have ordinal properties, necessitating the extensive use of non-parametric statistics. Residents' expressions of satisfaction with the component elements of the environment (ranging from convenience to upkeep and privacy) were successfully related to 'objective' measures of the environment. However the survey evidence did not justify the use of the 'objective' variables as environmental standards. A method of using the social survey data directly as an aid to decision-making is discussed. Alternative models of the derivation of overall satisfaction with the environment are tested, and the values implied by the additive model compared with residents' preferences as measured directly in the survey. Residents' overall satisfactions with the residential environment were most closely related to their satisfactions with the "Appearance" and the "Reputation" of their areas. By contrast the most important directly measured preference was "Friendliness of area". The differences point to the need to define concepts used in social research clearly in operational terms, and to take care in the use of values 'measured' by different methods.

Process improvement and quality management systems in the financial services industry:the case for the OPEX quality management system and framework

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