The spectrum of certain singular selfadjoint differential operators

Ph.D

Creativity in Science: Historical Illustrations and the Academic Paradigm

Koestler identifies creativity in terms of the ability of the individual to make analogies, the ability to recognize relationships between apparently unrelated events. Joseph Lister struggled with the unknown cause of sepsis, gangrene and suppuration in surgical wounds. Ignaz Philipp Semmelweis was immersed in his work to determine the cause of puerperal fever. Of many creative giants in the history of science, Walker places Pasteur among the best for his astonishing ability for seeing the salient factors of a problem. Boyer relates scholarship and creativity to academics who carry on research, publish, and perhaps relay to their students what they have discovered. Creativity is not easily defined nor explained, but the history of scientific discovery has provided some clues as to the nature of the creative person

Coal - Black Mammy

https://digitalcommons.library.umaine.edu/mmb-vp/1232/thumbnail.jp

Roanoke Revitalizes Its Downtown According to Public Demand

The city of Roanoke confronted the problems of a decaying downtown by recognizing that a new approach would be required to reverse the flight to the suburbs. Traditional programs had not worked or were stalled by the lack of public enthusiasm. Roanokers had, in the past, believed in downtown. To restore this belief would take more than talk about revitalization and rehabilitation planning. Action had to come from the citizens

Performance of Kentucky bluegrass varieties

1 online resource (PDF, 2 pages)This archival publication may not reflect current scientific knowledge or recommendations. Current information available from the University of Minnesota Extension: https://www.extension.umn.edu

Coal Black Mammy / music by Ivy St. Helier; words by Laddie Cliff

Cover: illustration of a peaceful Cotton Field (see #182); Publisher: Leo Feist Inc. (New York)https://egrove.olemiss.edu/sharris_d/1027/thumbnail.jp

Withdrawal of ventilatory support outside the intensive care unit: guidance for practice

To review the work of one tertiary paediatric palliative care service in facilitating planned withdrawal of ventilatory support outside the intensive care setting, with the purpose of developing local guidance for practice

Pharmacological interventions for pain in children and adolescents with life-limiting conditions

BACKGROUND: Pain is one of the most common symptoms in children and young people (CYP) with life-limiting conditions (LLCs) which include a wide range of diagnoses including cancer. The current literature indicates that pain is not well managed, however the evidence base to guide clinicians is limited. There is a clear need for evidence from a systematic review to inform prescribing. OBJECTIVES: To evaluate the evidence on the effectiveness of different pharmacological interventions used for pain in CYP with LLCs. SEARCH METHODS: The following electronic databases were searched up to December 2014: CENTRAL (in the Cochrane Library), MEDLINE, EMBASE, PsycINFO and CINAHL. In addition, we searched conference proceedings and reference lists of included studies. For completeness, we also contacted experts in the field. No language restrictions were applied. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-randomised studies and other studies that included a clearly defined comparator group were included. The studies investigated pharmacological treatments for pain associated with LLCs in CYP. The treatment included those specifically developed to treat pain and those that acted as an adjuvant, where the treatment was not primarily developed to treat pain but has pain relieving properties. The LLC was identified by its inclusion in the Richard Hain Directory of LLCs. DATA COLLECTION AND ANALYSIS: Citations were screened by five review authors. Data were extracted by one review author and checked by a second. Two review authors assessed the risk of bias of included studies. A sufficient number of studies using homogeneous outcomes was not identified so a meta-analysis was not possible. MAIN RESULTS: We identified 24,704 citations from our database search. Nine trials with 379 participants fulfilled our inclusion criteria. Participants had cerebral palsy (CP) in five of the studies and osteogenesis imperfecta (OI) in the other four. Participants across the trials ranged in age from 2 to 19 years. All studies, apart from one cross-over trial, were parallel designed RCTs. Three of the trials on CP evaluated intrathecal baclofen (ITB) and two botulinum toxin A (BoNT-A). All of the OI trials evaluated the use of bisphosphonates (two alendronate and one pamidronate). No trials were identified that evaluated a commonly used analgesic in this patient group. Pain was a secondary outcome in five of the eight identified studies. Overall the quality of the trials was mixed. Only one study involved over 100 participants.For the two ITB studies for pain in CP, in the same study population but assessed at different time points in their disease, both found an effect on pain favouring the intervention compared to the control group (standard care or placebo) (mean difference (MD) 4.20, 95% confidence interval (CI) 2.15 to 6.25; MD 26.60, 95% CI 2.61 to 50.59, respectively). In these studies most of the adverse events related to the procedure or device for administration rather than the drug, such as swelling at the pump site. In one trial there were also eight serious adverse effects; these included difficulty swallowing and an epileptic seizure. The trial did not state if these occurred in the intervention group. At follow-up in both BoNT-A trials there was no evidence of a difference in pain between the trial arms among CP participants. The adverse events in the BoNT-A trials mostly involved those who received the intervention drug and involved seizures. Gastrointestinal problems were the most frequent adverse event in those who received alendronate. The trial investigating pamidronate found no evidence of a difference in pain compared to the control group. No adverse events were reported in this trial. AUTHORS' CONCLUSIONS: Published, controlled evidence on the pharmacological interventions for pain in CYP with LLCs is limited. The evidence that is currently available evaluated pain largely as a secondary outcome and the drugs used were all adjuvants and not always commonly used in general paediatric palliative care for pain. Based on current data this systematic review is unable to determine the effects of pharmacological interventions for pain for CYP with LLCs. Future trials with larger populations should examine the effects of the drugs commonly used as analgesics; with the rising prevalence of many LLCs this becomes more necessary