Use of Intravenous Acetaminophen (Paracetamol) in a Pediatric Patient at the End of Life: Case Report

Abstract Background: For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. Discussion: In pediatric palliative care, acetaminophen is also used as an adjuvant to opioid therapy for pain as well as an anti-pyretic. For many pediatric patients near end-of-life, however, the ability to tolerate oral intake is diminished and rectal suppository administration can be distressing or contraindicated as in the setting of neutropenia, thus limiting use of acetaminophen by its usual routes. In Europe and Australia, an intravenous formulation of acetaminophen has been used for many years and has only recently become available in the United States. Conclusion: Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98460/1/jpm%2E2012%2E0117.pd

Deposition of High-Quality HfO2 on Graphene and the Effect of Remote Oxide Phonon Scattering

We demonstrate atomic layer deposition of high-quality dielectric HfO2 films on graphene and determine the magnitude of remote oxide surface phonon scattering in dual-oxide structures. The carrier mobility in these HfO2-covered graphene samples reaches 20 000 cm2/Vs at low temperature. Distinct contributions to the resistivity from surface optical phonons in the SiO2 substrate and the HfO2 overlayer are isolated. At 300 K, surface phonon modes of the HfO2 film centered at 54 meV limit the mobility to approximately 20 000 cm2/Vs

Resonant electron transmission through a finite quantum spin chain

Electron transport in a finite one dimensional quantum spin chain (with ferromagnetic exchange) is studied within an $s-d$ exchange Hamiltonian. Spin transfer coefficients strongly depend on the sign of the $s-d$ exchange constant. For a ferromagnetic coupling, they exhibit a novel resonant pattern, reflecting the salient features of the combined electron-spin system. Spin-flip processes are inelastic and feasible at finite voltage or at finite temperature.Comment: 4 pages including 4 .eps figure

A Communication Based Model of Power

We are affected greatly by power, and often do not understand what power is, how it is used, and its many other facets. Power and communication are interrelated, but how they relate to each other has been hard to understand. The model presented in this thesis explicates the relationship between the two critical variables. Power is portrayed as a hierarchical structure that is based on influence (communication) where the intensity and likelihood of success of power attempts increase as the level of power increases. The hierarchical structure has four levels, including influence at its base, and prominence, authority and control at the higher levels

Coupled Electronic and Nuclear Motions during Azobenzene Photoisomerization Monitored by Ultrafast Electron Diffraction

Ultrafast electron diffraction is a powerful technique that can resolve molecular structures with femtosecond and angstrom resolutions. We demonstrate theoretically how it can be used to monitor conical intersection dynamics in molecules. Specific contributions to the signal are identified which vanish in the absence of vibronic coherence and offer a direct window into conical intersection paths. A special focus is on hybrid scattering from nuclei and electrons, a process that is unique to electron (rather than X-ray) diffraction and monitors the strongly coupled nuclear and electronic motions in the vicinity of conical intersections. An application is made to the cis to trans isomerization of azobenzene, computed with exact quantum dynamics wavepacket propagation in a reactive two-dimensional nuclear space

Helping education undergraduates to use appropriate criteria for evaluating accounts of motivation

The aim of the study was to compare students in a control group with those in a treatment group with respect to evaluative comments on psychological accounts of motivation. The treatment group systematically scrutinized the nature and interpretation of evidence that supported different accounts, and the assumptions, logic, coherence and clarity of accounts. Content analysis of 74 scripts (using three categories) showed that the control group students made more assertions than either evidential or evaluative points, whereas the treatment group used evaluative statements as often as they used assertion. The findings provide support for privileging activities that develop understanding of how knowledge might be contested, and suggest a need for further research on pedagogies to serve this end. The idea is considered that such understanding has a pivotal role in the development of critical thinking

Changes in Achilles Tendon Thickness Following a 10 – Week Heavy Load Eccentric Exercise Program

Achilles tendinopathy (AT) is a common overuse injury in running or jumping activities where the tendon is unable to properly respond to the load. AT increases tendon thickness while decreasing stiffness and function (1). Studies have shown that tendon properties can be positively influenced by load (5,6). Therefore, AT has typically been treated conservatively through physical therapy, with eccentric calf strengthening exercises as the focus of the treatment (2)

Experienced tutors' deployment of thinking skills and what might be entailed in enhancing such skills

In the context of research that reports weaknesses in adults' critical thinking skills, the primary aim was to examine adults' use of critical thinking skills that are described in taxonomies and to identify areas for development. Position papers written by an opportunity sample of 32 experienced adult educators formed the data for a descriptive sample survey design intended to reveal participants' use of critical thinking skills. Each 6000-word paper was written during a development programme that supported such skills. A content analysis of the papers revealed that when participants drew on personal and published ideas about learning to derive their proposals for change, they accepted the ideas uncritically, thereby implying that they might find it difficult to help learners to examine ideas critically. The evidence supports research that implies that critical thinking skills are unlikely to develop unless overall course design privileges the development of epistemological understanding (King and Kitchener 1994, Kuhn 1999). A fundamental assumption underlying the study is that this understanding influences effective citizenship and personal development, as well as employability. A proposition that merits attention in future research is that the development of epistemological understanding is largely neglected in current curricula in formal post-16 education

Costs and Revenues Associated With Overweight Trucks in Indiana

This study established the unit costs of pavement and bridge damage due to overweight vehicles, and discussed issues concerning overweight vehicle e enforcement in Indiana. The study identified gaps in the existing practice and research, and established a practical framework that includes the development of asset families; establishment of realistic types and timings of reconstruction, rehabilitation, and maintenance, traffic volumes and growth projections; and damage cost estimation for each asset family and age group. The sensitivity of asset damage cost with respect to key policy and analysis variables was explored. Finally, the study examined the cost and operational issues associated with the enforcement of overweight truck policies. For pavement assets, the damage cost estimates were found to range from $0.006 per ESAL-mile on Interstates to$0.218 per ESAL-mile on non-national highways. The results also suggested that the pavement damage cost estimates are highly sensitive to the pavement life-cycle length, interest rate, rest period, and the costs and service lives of rehabilitation treatments. For bridges, an incremental-design methodology was used to assign damage cost to vehicle classes based on axle configurations and vehicle-miles of travel. Each FHWA vehicle weight group was classified into an equivalent AASHTO loading using the modified equivalent vehicle model which is based on gross vehicle weight, axle loading and axle spacing. Adopting a permit structure on the basis of gross vehicle weight only, will result in some vehicles underpaying by as much as 92% of their actual contribution to bridge damage. Finally, the study examined the cost and operational issues associated with the enforcement of overweight truck policies and made recommendations regarding equipment types and locations, staffing, and staff schedules, in order to promote cost-effective practices in weight enforcement