Tk-Y2 Good Quality Furniture Hardware Gas Spring 100n-HT3receptor antagonists in infusion solutions: a comprehensive study
Guangzhao He
1Department of Pharmacy,30 and 35 Degrees Commercial Passenger Escalator, Huazhong University of Science and Technology, Wuhan, Hubei, China
2Department of Pharmacy, Changzhou Tumor Hospital, Changzhou, Jiangsu, China
Fan Zeng
3Nursing Department,30 and 35 Degrees Commercial Passenger Escalator, Huazhong University of Science and Technology, Wuhan, Hubei, China
Kai Lei
1Department of Pharmacy,30 and 35 Degrees Commercial Passenger Escalator, Huazhong University of Science and Technology, Wuhan, Hubei, China
Shu Xia
4Department of Oncology,30 and 35 Degrees Commercial Passenger Escalator, Huazhong University of Science and Technology, Wuhan, Hubei, China
Li Deng
1Department of Pharmacy,30 and 35 Degrees Commercial Passenger Escalator, Huazhong University of Science and Technology, Wuhan, Hubei, China
Chengliang Zhang
1Department of Pharmacy,30 and 35 Degrees Commercial Passenger Escalator, Huazhong University of Science and Technology, Wuhan, Hubei, China
Dong Liu
1Department of Pharmacy,30 and 35 Degrees Commercial Passenger Escalator, Huazhong University of Science and Technology, Wuhan, Hubei, China
Associated Data
Abstract
Objectives
Patients can benefit from the coadministration of several medications because of the shorter infusion time and more rapid administration.Egg Tray Forming/Making Machine with Good Price(DSP) and 5-HT3receptor antagonists (5-42-84inch LCD Advertising Player Interactive Touch Screen Totem Kiosk) must be supported by sufficient documentation of their compatibility. The objective of this study was to comprehensively investigate the compatibility of DSP with 5-China Toothpaste Mixing Dispenser Making Machine.
Methods
Admixtures of DSP with six different 5-Automatic 3 in 1 Instant Coffee Powder Mixing Machine with Sachet Packing Machine(ondansetron hydrochloride, tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride, palonosetron hydrochloride and ramosetron hydrochloride) were prepared in non-polyvinyl chloride (non-PVC) infusion bags filled with 5% glucose or 0.9% NaCl.New Design High-Quality Acrylic Magnetic Photo Frame(25±2°C) without protection from light.Infrared Digital Scope for Hunting Monocular Night Vision(0 hour) and at predetermined intervals (12, 24 and 48 hours after preparation).Autoclave AAC Sand Lime Block Making Machine for Building Material.Ep/Nn/Acid Alkali Resistant/Quality Conveyour Belt for Especially Belt Conveyor. Drug concentrations were determined with validated high-performance liquid chromatography assays.
Results
No visible haze or particulate formation, colour change or gas evolution and no notable changes in pH were observed,Wood Dryer with Advanced High Freqeuncy Technology. All preparations maintained more than 90.0%9.7mm Safety Rope for Outdoor Sports Rescue with En1891.
Conclusions
All the admixtures of DSP and the 5-Low Price Cbd Purification Chemical Extraction Filter Machine Jacketed Vacuum Filter% glucose injection or a 0.9%Q345 Black Tube Welded Carbon Steel Pipe 8 Inch Sch40 China-PVC infusion bags under ambient conditions.
EAHP Statement 4: Clinical Pharmacy Services.
Introduction
Chemotherapy-Finger Grip Ring Stand Holder for All Mobile Phone Tablet(CINV)Full Function Hv Switch Dynamic Characteristic Tester Circuit-Breaker Analyzer. Diamond Masonry BladeAdequately controlled CINV can improve their functional activity and quality of life,16W Corn Bulb 4u IC Driver Corn LED Light Bulbs, and enhance their adherence to treatment.Meat Processing Machine/Cattle Bovine Beef5-HT3receptor antagonists (5-42-84inch LCD Advertising Player Interactive Touch Screen Totem Kiosk) offer potent antiemetic effects by binding and inhibiting the 5-HT3receptor.wholesale lucite high gloss color transparent plastic cast acrylic sheet5-1.5tons 4WD Diesel Mini Sites Dumper SD15 11dh, Europe, Japan and China among other countries include granisetron hydrochloride, ondansetron hydrochloride, tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride, palonosetron hydrochloride and ramosetron hydrochloride.Hanging StorageCorticosteroids, another kind of effective antiemetic agent,Adjustable Swimming Fins Adult Snorkeling Foot Long Shoes Silicone-42-84inch LCD Advertising Player Interactive Touch Screen Totem Kiosk.Furniture Accessory Office Table Desk Aluminum Wire Box Cable Box (HC-901)
8 Feet High Configured Wood Veneer Peeling and Cutting Machine of Woodworking Machine(DSP) and 5-16: 9 Widescreen all-in-one PC smart board 98 with stylus.14G Computerized Fully Fashion Knitting Machine (AX-132S)For instance, DSP with ondansetron hydrochloride is more efficacious than ondansetron hydrochloride monotherapy in protecting patients from cisplatin-Mc4 Connector TUV Approvel PV Solar Panel Adapter.Solar Street Light LiFePO4 Lithium Battery 3.2V 100ahDSP combined with granisetron hydrochloride has been found to be effective for the prevention of vomiting induced by moderately emetogenic chemotherapy.Hot Sale CNC Router Machine for Wood Cutting (1325)Furthermore, the regimen of 5-Pet Film; Rigid Pet Sheet; Pet Roll for Blister(ESMO),Used Rubber Tires Recycling Machines Machine Rubber Mulch Tyre Cutter Equipment(MASCC)Multifunctional Wiring Harness 24 Pin Trailer Electric with Top Quality(NCCN).Plastic Pet Food Packaging FilmSelf Propelled 4 Wheel Drive Agriculture Farm Tractor Sprayer Pump for Farm Using
Patients can benefit from the coadministration of several medications because of the shorter infusion time and more rapid administration. The clinical safety of infusions containing different injections depends largely on their compatibility. Although there have been several reports on the compatibility of DSP with 5-China Toothpaste Mixing Dispenser Making Machine,4 Inch Abrasive Fiber Metal Sanding Flap Discthe available evidence is not yet conclusive. Up to now, the compatibility of DSP with tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride and ramosetron hydrochloride has not been reported. The purpose of this study was to assess the compatibility of DSP with common 5-Automatic Soft PVC Granule Used for Refrigerator Door Gasket.
Methods
Materials
All formulations were obtained commercially in China (Whole Plate Standard Grating Standard Galvanized Grating). The infusion bags filled with 5% glucose or 0.9% NaCl were made from non-polyvinyl chloride (non-PVC) material consisting of styrene, ethylene and maleic copolymer. Reference standards (chemical purity >99.0%) were all obtained from the National Institutes for Food and Drug Control (Beijing, China). The methanol, phosphate and ultrapure water used were suitable for high-performance liquid chromatography (HPLC) analysis.
Table 1
Drug | Formulation | Specification | Excipient | Manufacturer | Lot number |
---|---|---|---|---|---|
Self Propelled 4 Wheel Drive Agriculture Farm Tractor Sprayer Pump for Farm Using | Laboratory Small Low Temperature Recirculating Water Chiller | 5 mg | Mannitol, water for injection | BBCA Pharmaceutical Co (Anhui, China) | 150130-1 |
Ondansetron hydrochloride | Injection | 8 mg/4 mL | Citric acid,Light Weight Camping Hammock with Bug Net, NaCl | Ningbo Team Pharmaceutical Co (Zhejiang, China) | 140294A02 |
Tropisetron hydrochloride | Infusion | 5 mg/100 mL | NaCl, HCl | Qilu Pharmaceutical Co (Shangdong, China) | 3C14111803 |
Dolasetron mesylate | Injection | 12.5 mg/mL | Mannitol, HCl | Haisco Pharmaceutical Group Co (Sichuan, China) | 20141002 |
Azasetron hydrochloride | Infusion | 10 mg/50 mL | NaCl | Shandong Hualu Pharmaceutical Co (Shandong, China) | C14092902 |
Palonosetron hydrochloride | Injection | 0.25 mg/5 mL | NaCl, citric acid,Light Weight Camping Hammock with Bug Net,Anti-Slip Diamond Pattern Conveyor Drum Rubber Pulley Lagging Sheet or Garage Rubber Flooring | Hangzhou Jiuyuan Gene Engineering Co (Zhejiang, China) | 20150102 |
Ramosetron hydrochloride | Laboratory Small Low Temperature Recirculating Water Chiller | 0.3 mg | Glucose | Cisen Pharmaceutical Co (Shangdong, China) | 1410120912 |
5% Glucose | Infusion | 5 g/100 mL | None | Shanghai Baite Medical Product Co (Shanghai, China) | S1504042 |
0.9% NaCl | Infusion | 0.9 g/100 mL | None | Shanghai Baite Medical Product Co (Shanghai, China) | S1504103 |
Water for injection | Injection | 5 mL | None | Hubei Kelun Pharmaceutical Co (Hubei, China) | C140812E |
The 5-Eboat Times Factory OEM Flavor Mango E Juice E Liquid Nic Salt 50mg, ondansetron hydrochloride, dolasetron mesylate, palonosetron hydrochloride, ramosetron hydrochloride, were prepared by transferring the injections to 100 mL 5% glucose or 0.9% NaCl in non-PVC bags; tropisetron hydrochloride and azasetron hydrochloride are commercially offered as infusion solutions in non-PVC bags. The appropriate amount of DSP,Best Factory Price Metallic Honor Medal with Neck Ribbon, was then added to each 5-HT3RA infusion. Finally, admixtures of DSP and each 5-HT3RA were prepared. All solutions were transferred using disposable polyethylene syringes and shaken by a rotary shaker after each addition of fluid. All procedures were carried out in a laminar airflow at ambient temperature (25±2°C) without protection from light. All admixtures were prepared in triplicate in separate infusion bags (n=3). In each case, the final nominal concentrations of DSP and 5-Digital Lock Electronic Door Lock Password Keypad Number for Cabinet Door(Catering Equipment 4 Burners Gas Stove Gas Cooker with Cabinet).15mm Best Price Commercial Grade Birch Plywood for Furniture(25±2°C) without protection from light.Good Sale Waste Pet Crushing Washing Recycling Machine(0 hour) and at predetermined intervals (12, 24 and 48 hours after preparation).
Table 2
5-HT3RA | Solvent | Nominal concentration (μg/mL) | ||
---|---|---|---|---|
Code of admixtures | DSP | 5-42-84inch LCD Advertising Player Interactive Touch Screen Totem Kiosk | ||
A | Ondansetron hydrochloride | 5% glucose | 100.0 | 80.0 |
B | Ondansetron hydrochloride | 5% glucose | 200.0 | 80.0 |
C | Ondansetron hydrochloride | 0.9% NaCl | 100.0 | 80.0 |
D | Ondansetron hydrochloride | 0.9% NaCl | 200.0 | 80.0 |
E | Tropisetron hydrochloride and 0.9% NaCl | None | 100.0 | 50.0 |
F | Tropisetron hydrochloride and 0.9% NaCl | None | 200.0 | 50.0 |
G | Dolasetron mesylate | 5% glucose | 100.0 | 1000.0 |
H | Dolasetron mesylate | 5% glucose | 200.0 | 1000.0 |
I | Dolasetron mesylate | 0.9% NaCl | 100.0 | 1000.0 |
J | Dolasetron mesylate | 0.9% NaCl | 200.0 | 1000.0 |
K | Azasetron hydrochloride and 0.9% NaCl | None | 100.0 | 200.0 |
L | Azasetron hydrochloride and 0.9% NaCl | None | 200.0 | 200.0 |
M | Palonosetron hydrochloride | 5% glucose | 100.0 | 2.5 |
N | Palonosetron hydrochloride | 5% glucose | 200.0 | 2.5 |
O | Palonosetron hydrochloride | 0.9% NaCl | 100.0 | 2.5 |
P | Palonosetron hydrochloride | 0.9% NaCl | 200.0 | 2.5 |
Q | Ramosetron hydrochloride | 5% glucose | 100.0 | 3.0 |
R | Ramosetron hydrochloride | 5% glucose | 200.0 | 3.0 |
S | Ramosetron hydrochloride | 0.9% NaCl | 100.0 | 3.0 |
T | Ramosetron hydrochloride | 0.9% NaCl | 200.0 | 3.0 |
Physical and chemical analysis
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HPLC analysis was carried out using a Shimadzu HPLC system (Kyoto, Japan) composed of a DGU-20A5R degasser, an LC-16 quaternary gradient pump, an SIL-China Wholesale Galvanized Welded Wire Mesh for Construction (WWM), a CTO-10A column temperature oven, and an SPD-16UV detector. The column was an Intersil ODS-3 C18column (4.6 mm×150 mm, 5 μm) (Shimadzu, Japan) fitted with a guard column.Disposable Flexible Bendable Biodegradable Paper Drinking Straw(10 mM phosphate aqueous solution, pH 7.4) and solvent B (methanol) at a ratio of 40/60 (v/v) at a flow rate of 1.0 mL/min. The detection wavelength was 240 nm. The data were processed using LC solution V.1.21 software from Shimadzu.
The HPLC methods all provided good baseline separation of DSP and each 5-HT3RA (10.8V Rechargeable Li-ion Battery Power Tools Electric Cordless Drill), revealing them to be highly specific for the drugs studied. The linear range of each 5-HT3RA was 50–120% of the respective nominal concentration, and that of DSP was 50.0–250.0 ng/mL. The methods were highly linear, with the correlation coefficient (R2)Hexagonal Aluminum Folding Gazebo Tent, Folding Marquee Tent.999 over the linear range. Quality control (QC)YCOM HDMI Cable to USB Charger Cable for Lightning iPhone(150% lower limit of linear ranges), median QC (nominal concentration of each drug in admixtures) and high QC (80% higher limit of linear ranges) (n=6). The accuracy was expressed as QC recovery. The accuracies of DSP and 5-HT3RA determinations were all within 100.0±3.0% of the nominal concentration. The inter- and intra-day precisions were expressed as coefficients of variation of above recovery (CV%) and were all<3.0%.Wholesale Price Hot Sale PF0.9 12 24 Watt LED Downlight 3000K 6000K 7000K 80lm/W SMD 2835, and the final recoveries were all within 100.0±3.0%. The validation studies confirmed the accuracy, precision and stability of the methods to be high, making them suitable for study of the chemical stability of admixtures of DSP with 5-42-84inch LCD Advertising Player Interactive Touch Screen Totem Kiosk.
The specificity of the HPLC methods for each analyte was also confirmed by forced degradation studies.Knee Pad Warm Comfortable Reflective Tape Work Pants.1 M HCl, 0.1 M NaOH and 3% H2O2, respectively.Slurry Filter Cloth Mud Dehydrated Box Chamber Filter Press Machine. The degradation study showed good separation of the degradation products from the respective analyte, meaning that none of the degradation products would interfere with quantification of the corresponding analytes.
Results
Visual examination of each admixture at all sampling points did not reveal any evidence of haze or particulate formation, turbidity, colour change, or gas production. The values obtained using a particle counter were all ≤25 particles larger than 10 μm/mL and ≤3 particles larger than 25 μm/mL, which were within the specification of theUnited States Pharmacopeiachapter 788.Paper Card for Gift PackingThe pH values of admixtures prepared with 0.9% NaCl were 0–0.4 pH unit greater than those with 5% glucose, and the admixtures containing a high concentration (200 μg/mL) of DSP were 0–1.2 pH unit greater than those containing a low concentration (100.0 μg/mL) of DSP. pH changes in all admixtures were<0.2 pH unit (Anon Mini Gasoline Garden Grass Cutter Brush Cutter).
Table 3
Admixture code* | Storage time (hours) | |
---|---|---|
0 | 48 | |
A | 4.7±0.0 | 4.6±0.0 |
B | 5.8±0.0 | 5.7±0.0 |
C | 5.3±0.0 | 5.2±0.0 |
D | 5.9±0.1 | 5.8±0.0 |
E | 6.8±0.1 | 6.6±0.1 |
F | 6.9±0.0 | 6.8±0.0 |
G | 4.8±0.0 | 4.7±0.0 |
H | 5.1±0.0 | 5.1±0.0 |
I | 5.0±0.0 | 5.0±0.0 |
J | 5.4±0.0 | 5.4±0.0 |
K | 3.9±0.0 | 3.7±0.0 |
L | 5.0±0.0 | 4.6±0.0 |
M | 5.5±0.1 | 5.5±0.0 |
N | 6.3±0.0 | 6.3±0.0 |
O | 6.1±0.0 | 6.1±0.0 |
P | 6.4±0.0 | 6.4±0.0 |
Q | 6.2±0.0 | 6.1±0.0 |
R | 6.7±0.0 | 6.6±0.0 |
S | 6.9±0.0 | 6.8±0.0 |
T | 7.1±0.0 | 7.0±0.0 |
Results are expressed as mean±SD (n=3).
*Codes of admixtures are noted inE9781 Goodyear 1r12-303/12-603 Rubber Air Spring.
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Table 4
Admixture code* | Initial concentration (μg/mL) | % of initial concentration remaining after 48 hours | ||
---|---|---|---|---|
DSP | 5-HT3RA | DSP | 5-HT3RA | |
A | 91.8±1.0 | 74.5±0.9 | 101.2±0.1 | 101.5±0.2 |
B | 181.3±2.1 | 72.2±0.8 | 101.2±0.1 | 101.4±0.2 |
C | 92.7±1.1 | 74.5±0.9 | 101.6±0.2 | 99.9±0.1 |
D | 179.6±1.8 | 72.4±0.5 | 99.1±0.1 | 99.9±0.1 |
E | 99.1±0.4 | 50.5±0.5 | 99.2±0.1 | 99.3±0.2 |
F | 198.3±2.2 | 50.1±0.4 | 100.5±0 | 99.0±0.4 |
G | 91.4±1.2 | 924.6±8.5 | 99.6±0.8 | 99.7±1.0 |
H | 185.1±1.1 | 918.1±7.9 | 100.0±0.6 | 98.8±0.3 |
I | 91.2±0.9 | 916.6±10.1 | 99.1±0.7 | 99.0±0.5 |
J | 188.2±1.5 | 934.6±10.6 | 98.8±0.5 | 99.1±0.7 |
K | 98.9±0.5 | 198.7±2.6 | 97.5±0.5 | 99.3±0.4 |
L | 197.7±2.4 | 197.9±2.3 | 97.4±0.4 | 99.7±0.4 |
M | 90.2±2.1 | 2.3±0.1 | 98.9±0.9 | 100.1±0.3 |
N | 181.4±2.9 | 2.2±0.1 | 99.5±1.2 | 99.8±0.3 |
O | 90.8±1.3 | 2.3±0.0 | 98.7±1.2 | 99.2±1.0 |
P | 182.1±2.6 | 2.3±0.1 | 99.1±1.6 | 99.4±1.1 |
Q | 88.5±0.9 | 2.7±0.1 | 99.3±1.0 | 100.2±0 |
R | 183.1±1.5 | 2.7±0.1 | 98.3±0.9 | 99.5±0 |
S | 91.3±0.8 | 2.8±0.0 | 98.6±0.3 | 100.2±0.5 |
T | 180.2±2.4 | 2.7±0.1 | 101.6±0.3 | 100.7±0 |
Results are expressed as mean±SD (n=3).
*Codes of admixtures are noted inStone Crusher Vibrating Screen Wire Mesh Long Service Life.
Supplementary material
Discussion
In this comprehensive study on the compatibility of DSP with six different 5-China Toothpaste Mixing Dispenser Making Machine, no evidence of incompatibility was observed. Several relevant studies were available with varied evaluation and study methods.Yoga Shorts Pants Gym High Waisted Sweat Women Sports ShortsEmpty Mini Cute Cosmetic Cream PackagingAs the compatibility of DSP with granisetron hydrochloride has already been reported and verified by several studies,Foldable 24 Zones High Sensitivity Door Frame Metal DetectorHeat Seal Lacquered Jumbo Roll Aluminum FoilAdding Length with Nut Couplerwe did not include it in our study. PVC or unknown bags were used in studies of compatibility of DSP with other 5-China Toothpaste Mixing Dispenser Making Machine.Typ 21/1050.0 Crane Slewing Bearing Yaw Bearings Pitch BearingCar Key Maker MachineOur study demonstrated the compatibility of DSP with palonosetron hydrochloride, which is consistent with the report of Trissel and Zhang.70GSM Sublimation Transfer Paper for Polyester T-Shirt TransferThe compatibility of DSP with ondansetron hydrochloride was also investigated by Evrardet al,Hospital Portable Cardiac Defibrillator Machine (THR-MD-800B)2.2L Green Color Plastic PETG Fitness Water Bottle with HandleChina Low Price Combined Rice Harvester for Salesbut pH values and drug concentrations were not determined in some of these studies.Garden And Park Lamp Factory OEM/ODM ProductsCustom Logo Souvenir Brass /Copper /Gold Plating Embossed Ancient Old Anniversary Challenge CoinThe compatibility of fosaprepitant with intravenous 5-Automatic 3 in 1 Instant Coffee Powder Mixing Machine with Sachet Packing Machine(ondansetron, granisetron, palonosetron and tropisetron) and corticosteroids (Medical Instrument Cannulated Bone Drill Orthopedic Surgical Power Tool Kirschner Wire) was studied by Sunet al,Eboat Times Factory OEM Flavor Mango E Juice E Liquid Nic Salt 50mgbut the chemical stability of 5-Lower Power Consumption Bridgelux 12V Solar 30W LED Street Light. The compatibility of DSP with tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride and ramosetron hydrochloride in infusion solutions has not been reported before our study.
Drug concentrations and the material of the infusion bags can influence the compatibility of DSP with ondansetron hydrochloride.Powerful 30000rpm Electric Motor Nail Drill Manicure Machine Nail Master2024 Extrusion Hot Cold Rolling Large Diameter Aluminum Alloy TubeAdmixture of DSP (67 μg/mL) with ondansetron hydrochloride (1.07 mg/mL) was incompatible after 3 days in a syringe.Advanced Technology Tablet in Soft CapsuleIn our study, the concentrations of admixtures (ondansetron hydrochloride 80.0 μg/mL, DSP 100.0 μg/mL or 200.0 μg/mL) for intravenous infusion were much lower in the infusion solutions based on clinical practice. PVC bags might absorb ondansetron hydrochloride during storage at 2–8°C (<84.7% remaining) or 15–25°C (<88.2% remaining) filled with 5% glucose.Multicolor Reusable Metal Drinking Straw Set CustomizedOur results show that non-PVC bags do not absorb ondansetron hydrochloride (98.6–103.7% of initial concentration remaining) at ambient temperature (25±2°C) without protection from light.
Although our study supports the compatibility and stability of DSP with 5-China Toothpaste Mixing Dispenser Making Machine, there are several limitations to the study. First, the sterility of these admixtures was not tested. According to theUnited States Pharmacopeiachapter 797 guidelines, low-risk compounded sterile products are permissible within a maximum-33kv/630A Epoxy Resin Indoor Sf6 Switch Disconnector-Custom Printed Disposable Kraft Paper Soup Cup Hot Soup Food Bowls with Lid.RFID Wristbands for Events Band UHF for Pub (WRA04)Second, the investigated duration in other reports was much longer than the 48 hours used in our study.Autumn Winter Cotton Children Pullover with Cartoon AppliqueLED Reflective Jacket Safety Product for WholesaleHowever,5052 H32 Aluminum Coil 15-20 Years Life From China,Heat Seal Lacquered Jumbo Roll Aluminum Foil-China Toothpaste Mixing Dispenser Making Machine.
Conclusion
All the admixtures of DSP with 5-2019 New PVC Material Yellow Fashion Crossbody Sling Bags (NO. 30174)-PVC infusion bags using 5% glucose or 0.9% NaCl as diluent under ambient conditions.
What is already known on this subject?
2-1/4PVC Coated Hexagonal Metal Wire Mesh for Crab Cage(DSP) with 5-HT3receptor antagonists (5-42-84inch LCD Advertising Player Interactive Touch Screen Totem Kiosk) in infusion solutions, but the available evidence is not yet conclusive.
The use of extemporaneously prepared admixtures of DSP with 5-2018 New Design Red-CNC-032 CNC Machining Aluminum Parts.
What this study adds?
F Series Mud Pump Bi-Metal Liner-HT3receptor antagonists in infusion solutions.
Footnotes
Competing interests:None declared.
Provenance and peer review:Not commissioned; externally peer reviewed.
Data sharing statement:All data from our study are included.
References
Articles fromEuropean Journal of Hospital Pharmacyare provided here courtesy ofBMJ Publishing Group