Subcutaneous delivery of sumatriptan in the treatment of migraine and primary headache

Subcutaneous sumatriptan is an effective treatment for pain from acute migraine headache, and can be used in patients with known migraine syndrome and in patients with primary headaches when secondary causes have been excluded. In limited comparative trials, subcutaneous sumatriptan performed in a manner comparable with oral eletriptan and intravenous metoclopramide, was superior to intravenous aspirin and intramuscular trimethobenzamide-diphenhydramine, and was inferior to intravenous prochlorperazine for pain relief. The most common side effects seen with subcutaneous sumatriptan are injection site reactions and triptan sensations. As with all triptans, there is a risk of rare cardiovascular events with subcutaneous sumatriptan and its use should be limited to those without known cerebrovascular disease and limited in those with known cardiovascular risk factors and unknown disease status. In studies of patient preference and tolerability, the subcutaneous formulation has a faster time of onset and high rate of efficacy when compared with the oral formulation, but the oral formulation appears to be better tolerated. It is important to consider the needs of the patient, their past medical history, and what aspects of migraine treatment are most important to the patient when considering treatment of acute migraine or primary headache. Subcutaneous sumatriptan is a good first-line agent for the treatment of pain from acute migraine headaches and primary headaches

The Physiologic Effects of Multiple Simultaneous Electronic Control Device Discharges

Objectives: Law enforcement and military personnel use electronic control devices to control non-compliant and actively resistive subjects. The TASER® Shockwave is a new electronic control device designed specifically as an area denial device capable of delivering multiple simultaneous discharges. This is the first study to examine the effects of multiple simultaneous device discharges in humans.Methods: Volunteers were exposed to multiple (two to three), simultaneous 5-second discharges from the Shockwave device to the chest, back, chest to abdomen, or thighs. Blood was analyzed before and after discharge for pH, lactate, potassium, creatine kinase (CK), and troponin. Continuous spirometry was performed before, during, and after the discharge. In addition, electrocardiograms (ECGs) before and after discharge were recorded, and echocardiography was used to determine the rhythm during discharge.Results: Small elevations of lactate occurred. Moderate increases in CK at 24 hours occurred and appeared to be related to the number of simultaneous discharges. There was a trend to a decrease in minute ventilation in the volunteers exposed to two simultaneous discharges, but it did not reach statistical significance. ECG changes only reflected an increase in vagal tone, and there was no evidence of capture by echocardiography. Five-second, simultaneous, multiple exposures to the TASER Shockwave device were reasonably tolerated by our human volunteers.Conclusion: Our study suggests that this device may have a reasonable risk/benefit ratio when used to protect an area from a threat. [West J Emerg Med. 2010; 11(1):49-56]

Energetic Adaptations along a Broad Latitudinal Gradient: Implications for Widely Distributed Assemblages

Most community-based models in ecology assume that all individuals within a species respond similarly to environmental conditions and thereby exert identical effects as consumers or prey. Rather, individuals differ among systems, with important implications for population demographics and community interactions. For widely distributed assemblages made up of poikilotherms with high first-year mortality, species-specific differences in growth reaction norms as affected by both temperature and genotype will influence biotic interactions. For a broadly distributed fish assemblage, first-year growth does not vary with latitude for a planktivorous prey species, but declines with increasing latitude for a terminal piscivore. Size-based competitive interactions between these species are likely to be more intense at high latitudes, as they spend an extended time sharing resources during early life. Such patterns probably are pervasive and must be considered when seeking to understand species interactions. Improving our knowledge of how temperature and local adaptations affect size-based interactions should enhance our ability to manage and conserve widespread assemblages

Discharge characteristics at bioswale installation sites along I-294 in northern Cook County, Illinois

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Educating the public health workforce: Issues and challenges

Background: In public health, as well as other health education contexts, there is increasing recognition of the transformation in public health practice and the necessity for educational providers to keep pace. Traditionally, public health education has been at the postgraduate level; however, over the past decade an upsurge in the growth of undergraduate public health degrees has taken place. Discussion: This article explores the impact of these changes on the traditional sphere of Master of Public Health programs, the range of competencies required at undergraduate and postgraduate levels, and the relevance of these changes to the public health workforce. It raises questions about the complexity of educational issues facing tertiary institutions and discusses the implications of these issues on undergraduate and postgraduate programs in public health. Conclusion: The planning and provisioning of education in public health must differentiate between the requirements of undergraduate and postgraduate students – while also addressing the changing needs of the health workforce. Within Australia, although significant research has been undertaken regarding the competencies required by postgraduate public health students, the approach is still somewhat piecemeal, and does not address undergraduate public health. This paper argues for a consistent approach to competencies that describe and differentiate entry-level and advanced practice

The effects of bioswale construction on groundwater adjacent to I-294 in northern Cook County, Illinois

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Using bioswales to improve the quality of roadway runoff from I-294 in northern Cook County, Illinois

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Reductions in turbidity and specific conductivity in runoff treated by bioswales along I-294 in northern Cook County, Illinois

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