Prophylaxis of Postoperative Nausea and Vomiting in Adolescent Patients: A Review with Emphasis on Combination of Fixed-Dose Ondansetron and Transdermal Scopolamine

Postoperative nausea and vomiting (PONV) is a relatively common occurrence (20–30%) that delays discharge and, if persistent, can lead to serious complications. The incidence of PONV is a function of patient characteristics, the type and duration of surgery, the type of anesthesia, and the choice of pre-, intra-, and postoperative pharmacotherapy. There are no completely effective antiemetic agents for this condition, but recommendations for treatment strategies are separately available for pediatric and adult patients. Left unclear is whether adolescents should be guided by the pediatric or the adult recommendations. We review the developmental physiology of the relevant physiological factors (absorption, distribution, metabolism, and elimination). We also review the clinical evidence regarding the safety and efficacy of a fixed-dose combination of ondansetron (4 mg, i.v.) and transdermal scopolamine (1.5 mg)

Gabapentinoid use disorder. Update for clinicians

Gabapentinoids (gabapentin and pregabalin) are versatile drugs, indicated mainly for epilepsy and neuropathic pain, and have long been viewed as agents with little potential for abuse. Burgeoning prescribing patterns and studies indicate that these drugs are increasingly being abused, particularly by polydrug abusers who also abuse opioids. Gabapentinoid abuse is found in less 2% of the general population but may be as high as 15% to 22% among opioid abusers. Other risk factors for gabapentinoid abuse are less clear-cut but include mental health disorders. Gabapentinoids are relatively easy for drug abusers to obtain and many clinicians are not fully aware of their abuse potential. It is thought that gabapentinoids may offer psychoactive effects or enhance the effects of other drugs of abuse. Those who discontinue gabapentinoids abruptly may suffer withdrawal symptoms, but gabapentinoid overdose fatality is rare. Since gabapentinoids are often prescribed off-label to treat psychiatric disorders, these drugs may be dispensed to a particularly vulnerable population. Clinicians must be aware of the potential for Gabapentinoid Use Disorder: Update for Clinicians

Schools of the Bible: Contours of a Divine Plan for Christian Education

God has communicated his divine plan for education through the Bible. He has revealed His educational model by means of various schools that He established throughout history. A number of schools are discussed in both the Old and New Testaments. Established in a variety of contexts, these schools of the Bible provide Christian educators with clarification of the divine plan for education, particularly as today’s educators seek to align contemporary educational systems with God’s plan for His children. This article will examine the roots of Christian education—the schools of the Bible—to reveal salient characteristics of these educational programs in order to better understand the purpose and identify appropriate methods of Christian education

Pain Management in the Elderly: An FDA Safe Use Initiative Expert Panel's View on Preventable Harm Associated with NSAID Therapy

Optimization of current pain management strategies is necessary in order to reduce medication risks. Promoting patient and healthcare provider education on pain and pain medications is an essential step in reducing inadequate prescribing behaviors and adverse events. In an effort to raise awareness on medication safety, the FDA has launched the Safe Use Initiative program. The program seeks to identify areas with the greatest amount of preventable harm and help promote new methods and practices to reduce medication risks. Since the establishment of the program, FDA's Safe Use initiative staff convened a panel of key opinion leaders throughout the medical community to address pain management in older adults (≥65 years of age). The aim of the expert panel was to focus on areas where significant risk occurs and where potential interventions will be feasible, implementable, and lead to substantial impact. The panel suggested one focus could be the use of NSAIDs for pain management in the elderly

Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

Monitored anesthesia care (MAC) is a safe, effective, and appropriate form of anesthesia for many minor surgical procedures. The proliferation of outpatient procedures has heightened interest in MAC sedation agents. Among the most commonly used MAC sedation agents today are benzodiazepines, including midazolam, and propofol. Recently approved in the United States is fospropofol, a prodrug of propofol which hydrolyzes in the body by alkaline phosphatase to liberate propofol. Propofol liberated from fospropofol has unique pharmacological properties, but recently retracted pharmacokinetic (PK) and pharmacodynamic (PD) evaluations make it difficult to formulate clear conclusions with respect to fospropofol's PK/PD properties. In safety and efficacy clinical studies, fospropofol demonstrated dose-dependent sedation with good rates of success at doses of 6.5 mg/kg along with good levels of patient and physician acceptance. Fospropofol has been associated with less pain at injection site than propofol. The most commonly reported side effects with fospropofol are paresthesia and pruritus. Fospropofol is a promising new sedation agent that appears to be well suited for MAC sedation, but further studies are needed to better understand its PK/PD properties as well its appropriate clinical role in outpatient procedures

A Visual Impact Assessment Methodology for the National Park Service

As the National Park Service (NPS) set out to create a visual resource management program, the first major component was the development of a robust visual resource inventory (VRI) process to identify, locate, and assess high value views, both within and near NPS units, based on both scenic quality and the importance of the view to the visitor experience. The next component in the program has been the development of a visual impact assessment (VIA) process to understand how changes in the landscape— whether inside the park or beyond its boundaries—could impact the scenic quality of valued views and visitor experience of those views. This presentation will discuss the NPS VIA process and highlight results of field-testing. Units of the National Park System encompass a wide variety of landscape types and visual settings. Particular views are enjoyed not only for scenic qualities but also appreciated for their historic and cultural values. NPS incorporates visible elements of views into their interpretive and educational activities. As a result, the NPS VRI was designed to identify not only the visual qualities of views but also the other values that make views important to NPS and park visitors. The NPS VRI was also built to support VIAs, both for NPS projects and actions within NPS unit boundaries, and projects and activities beyond NPS unit boundaries, where NPS is a stakeholder rather than a permitting agency. The detailed information from the VRI provides a sound basis for articulating the full effects of a proposed project or activity, which may go far beyond measuring visual contrast and other more purely scenic aspects of visual impact. Building on the inventory process the NPS visual impact assessment (VIA) methodology identifies the expected level of visual change from a proposed project or activity, and assesses the likely effects of the change on scenic quality as determined in the VRI. The NPS VIA approach provides parks with information to pursue better planning and design for park projects and credible support for understanding and communicating the potential impacts of changes beyond park boundaries

Academic Library and Publisher Collaboration: Utilizing an Institutional Repository to Maximize the Visibility and Impact of Articles by University Authors

The George A. Smathers Libraries (Libraries) (http://www.uflib.ufl.edu/) at the University of Florida (UF) (http://www.ufl.edu/) and Elsevier (http://www.elsevier.com) have embarked on a pilot project to maximize visibility, impact, and dissemination of articles by UF researchers who have published in Elsevier journals. Article links and metadata are automatically delivered to UF’s Institutional Repository, the IR@UF (http://ufdc.ufl.edu/ir), in the IR@UF-Elsevier Collection (http://ufdc.ufl.edu/ielsevier). The metadata, with links for approximately 31,000 articles by UF authors, is made possible through integration of the IR@UF with the ScienceDirect application programming interfaces (APIs) (https://www.elsevier.com/solutions/sciencedirect/support/institutional-repository) that are freely available to libraries. Access to the full text on ScienceDirect is available for all institutional repository users affiliated with a subscribing institution. In the next phase users without subscriptions will be able to access the manuscripts of articles published from 2013 forward. This will be done by embedding metadata and links to accepted manuscripts available on ScienceDirect into the IR@UF. We will conduct user and usability testing of this cross-platform user experience. This article provides an overview of the project’s current status, how it works, what it delivers, and next steps expanding the project to include articles by UF authors from other publishers. It concludes with strategic considerations, future developments, and reflections on the value of library/publisher collaboration

Tissue Tropism in Host Transcriptional Response to Members of the Bovine Respiratory Disease Complex.

Bovine respiratory disease (BRD) is the most common infectious disease of beef and dairy cattle and is characterized by a complex infectious etiology that includes a variety of viral and bacterial pathogens. We examined the global changes in mRNA abundance in healthy lung and lung lesions and in the lymphoid tissues bronchial lymph node, retropharyngeal lymph node, nasopharyngeal lymph node and pharyngeal tonsil collected at the peak of clinical disease from beef cattle experimentally challenged with either bovine respiratory syncytial virus, infectious bovine rhinotracheitis, bovine viral diarrhea virus, Mannheimia haemolytica or Mycoplasma bovis. We identified signatures of tissue-specific transcriptional responses indicative of tropism in the coordination of host's immune tissue responses to infection by viral or bacterial infections. Furthermore, our study shows that this tissue tropism in host transcriptional response to BRD pathogens results in the activation of different networks of response genes. The differential crosstalk among genes expressed in lymphoid tissues was predicted to be orchestrated by specific immune genes that act as 'key players' within expression networks. The results of this study serve as a basis for the development of innovative therapeutic strategies and for the selection of cattle with enhanced resistance to BRD

Measurement of Optical Response of a Detuned Resonant Sideband Extraction Interferometer

We report on the optical response of a suspended-mass detuned resonant sideband extraction (RSE) interferometer with power recycling. The purpose of the detuned RSE configuration is to manipulate and optimize the optical response of the interferometer to differential displacements (induced by gravitational waves) as a function of frequency, independently of other parameters of the interferometer. The design of our interferometer results in an optical gain with two peaks: an RSE optical resonance at around 4 kHz and a radiation pressure induced optical spring at around 41 Hz. We have developed a reliable procedure for acquiring lock and establishing the desired optical configuration. In this configuration, we have measured the optical response to differential displacement and found good agreement with predictions at both resonances and all other relevant frequencies. These results build confidence in both the theory and practical implementation of the more complex optical configuration being planned for Advanced LIGO.Comment: 6 pages, 4 figures, for submission to Phys Rev Letter