Caution Is Warranted

Of course, many organizations have completed large systems projects with better success. And often the fault lies with the implementers, not the software. The examples cite the application category called ERP. ERP systems automate back-office operations. The back office consists of the many transactions fundamental to the business. Examples are personnel records, booking sales, product bill of materials, and ordering materials. 

TABLE 25.1 CSCMP Logistics Software Directory General Functional Areas 

Customer Relationship Management Forecasting Inventory Planning/Management 

Manufacturing Order Processing Other Advanced Planning 

The next drivers for systems improvements will be gaining strategic value in addition to financial returns from the technology. For example, a driver for a technology such as RFID (radio frequency identification) is the need to comply with mles from channel masters Wal-Mart and the Department of Defense. 

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Cussler studied diffusion in concentrated associating systems and has shown that, in associating systems, it is the size of diffusing clusters rather than diffusing solutes that controls diffusion. is a reference diffusion coefficient discussed hereafter is the activity of component A and iC is a constant. By assuming that could be predicted by Eq. (5-223) with P = 1, iC was found to be equal to 0.5 based on five binaiy systems and vahdated with a sixth binaiy mixture. The limitations of Eq. (5-225) using and K defined previously have not been explored, so caution is warranted. Gurkan showed that K shoiild actually be closer to 0.3 (rather than 0.5) and discussed the overall results. 

The extent to which these Flory interaction parameters apply to the pyridine-insoluble portion of the Illinois No. 6 coal is open to question. We cannot address this aspect fully here, but we have noted that the pyridine-soluble and -insoluble portions of the Illinois No. 6 coal studied here have similar carbon, hydrogen and oxygen contents. Maciel has observed that the aromaticities of the two portions of an Illinois No. 6 coal are similar as well.(12) Based on this alone, it seems that the pyridine-soluble portion is representative of the larger, crosslinked portion, at least for the Illinois No. 6 coal, but this aspect remains controversial,(12) so caution is warranted. 

Mivacurium chloride (Mivacron) is a newer agent that is chemically related to atracurium. The primary mechanism of inactivation is hydrolysis by plasma cholinesterase. Although it is useful for patients with renal or hepatic disease, some caution is warranted, since these individuals may have reduced plasma cholinesterase as a result of the disease. Mivacurium has an onset of action (1.8 minutes) and duration of effect (20 minutes) only twice that of succinylcholine, and in this respect, it is the most similar to succinylcholine of all of the nondepolarizing agents. 

Theophylline should be used with caution in patients with myocardial disease, liver disease, and acute myocardial infarction. The half-life of theophylline is prolonged in patients with congestive heart failure. Because of its narrow margin of safety, extreme caution is warranted when coadministering drugs, such as cime-tidine or zUeuton, that may interfere with the metabolism of theophylline. Indeed, coadministration of zileu-ton with theophylline is contraindicated. It is also prudent to be careful when using theophylline in patients with a history of seizures. 

Children with pervasive developmental disorders are also at higher risk for developing TS. In a recent survey of 447 pupils from nine schools for children and adolescents with autism, 19 children were found to have definite TS, yielding a prevalence rate of 4.3% (Baron-Cohen et ah, 1999). However, caution is warranted, as complex motor tics can be difficult to distinguish from motor stereotypies, and differentiation among these behaviors may be especially problematic among retarded individuals with limited verbal skills. 

Antihistamines such as diphenhydramine, a mainstay of OTC sleep preparations, are also used widely by parents for their children at doses of 1 mg/kg. Most of the reports of the use of clonidine for sleep disorders are clinical and anecdotal case reports of use in children with ADFFD (Wilens et ah, 1994 Prince et ah, 1996). There are some safety concerns about using clonidine once a day at bedtime, especially in patients who take a daytime stimulant. Melatonin was studied using a double-blind, placebo-controlled, crossover design (Jan et ah, 1994) on a mixed group of 15 children with sleep disturbances, with some improvement reported. However, caution is warranted in using this agent because melatonin is unregulated, and there are concerns about the purity and safety of some commercially available preparations (Werry and Aman, 1999). 

In vitro data suggest that bupropion is metabohzed by CYP 2B6. Bupropion inhibits CYP 2D6. Because of the risk of dose-dependent seizures, caution is warranted when bupropion is combined with other medications that might inhibit its metabolism. 

All cholinesterase inhibitors should be used with caution in patients with cardiac conduction problems because vagotonic effects can lead to bradycardia. In addition, caution is warranted in patients with comorbid asthma, chronic obstructive pulmonary disease, bladder outlet obstruction, or seizures, as well as in patients at risk for gastrointestinal ulcers or bleeding (Fuller and Sajatovic 2000). 

Because heating in water alone did not improve immunostaining, it is concluded that epitope retrieval is mediated not only by heat and rehydration but also by the presence of a chelating agent such as EDTA. However, caution is warranted in using EDTA, which may adversely affect cell morphology because it is a strong oxidant. 

Note that immunohistochemical reactions do not always yield homogeneous results but are subject to variations from slide to slide and from case to case. Because tumors are heterogeneous, caution is warranted in assuming that a particular section of the tumor is representative of the whole tumor (see page 14 for discussion on tumor heterogeneity). 

In short, biomonitoring communicators should not extrapolate from relative exposure to the absolute likelihood of adverse health effects. Comparison of study with reference-population biomarker concentrations cannot be informative about such likelihood, for reasons discussed at length in Chapter 5. At best, such comparisons can inform only about relative likelihood, and even then caution is warranted. 

This method of estimating Rc is useful when it can be applied, since the determination is not based on any presumed model of the corrosion damage process or any of the assumptions that come with assignment of an equivalent circuit model. This method is particularly helpful when there is more than one time constant in the spectrum, or the impedance spectrum is particularly complicated. Caution is warranted however. This method of estimation can be in serious error for samples with large capacitance-dominated low-frequency impedances. As a general rule, for this estimation method to be reasonably accurate, the impedance function must exhibit a clear DC limit, or a diffusional response that can be modeled by a constant phase element in equivalent circuit analysis (75). 

Up to 10% of patients have to be withdrawn from treatment because of psychiatric symptoms. Bromocriptine-induced psychosis is well known and particular caution is warranted in patients with a family history of mental disorders (109). Even very low doses of bromocriptine can cause psychotic reactions (SEDA-9, 126) (SEDA-10, 117), and well-recognized problems include confusion, hallucinations, delusions, and paranoia. 

The similarities between non-ionic micelles and globular proteins (Nemethy, 1967 Schott, 1968 Jencks, 1969) render micelles potentially useful as models for the investigation of hydrophobic interactions. Indeed, the stability of non-ionic micelles has been treated theoretically in terms of hydrophobic interactions (Poland and Scheraga, 1965). Since the critical micelle concentration is related to the degree and nature of the hydrophobic interactions of the amphiphile, its valne in the presence of additives and at different temperatures can be nsed as a quantitative measure of the effect of these variables on the hydrophobic interactions. In spite of the similarities between proteins and micelles, considerable caution is warranted in extrapolating the results obtained from micellar models to the more complex protein systems. 

Naive Pooled Approach. The naive pooled approach, proposed by Sheiner and Beal, involves pooling all the data from all individuals as if they were from a single individual to obtain population parameter estimates.Generally, the naive pooled approach performs well in estimating population pharmacokinetic parameters from balanced pharmacokinetic data with small between-subject variations, but tends to confound individual differences and diverse sources of variability, and it generally performs poorly when dealing with imbalanced data. Additionally, caution is warranted when applying the naive pooled approach for PD data analysis because it may produce a distorted picture of the exposure-response relationship and thereby could have safety implications when applied to the treatment of individual patients. ... 

The sudden death of a patient using topical minoxidil (18) was probably not drug-related but due to cardiovascular disease and hypertension. Nevertheless, in patients who are known to be hypertensive and who are also receiving other antihypertensive medication extra caution is warranted when topical minoxidil is used (19). 

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