Review of oral oxymorphone in the management of pain

Chronic cancer and nonmalignant pain (CNMP) is a common and major health problem afflicting approximately 40 million persons in the US. Most cancer patients, and many patients with CNMP, require opioid analgesics to obtain adequate pain relief. Oral oxymorphone is a new formulation of an existing parenteral opioid that has become available for the treatment of significant pain: acute postoperative, chronic arthritis, chronic low back, and chronic cancer pain. Oxymorphone is a typical mu-opioid agonist that is effective in both immediate- and extended-release (IR and ER) formulations. Oxymorphone is more lipid soluble than morphine, resulting in a rapid onset of action when given in tablet formulation, with a duration of action of approximately 4–6 hours in IR and 12 hours in ER preparations. Oxymorphone provides excellent pain relief for significant pain, with typical opioid side effects that are usually mild or moderate in intensity. Multiple double-blind, prospective, placebo-controlled clinical trials have demonstrated the clinical efficacy and safety of this new oral opioid preparation. Oral oxymorphone is an effective opioid that provides a new therapeutic option for the physician

Designing with Care - Interior Design and Residential Child Care Final Report

This exploratory study examined the attitudes to a range of design interventions in four residential care homes for children in South Lanarkshire. The project set out to identify the benefits and disadvantages to young people and staff of a change in approach to the design of interior spaces. It was undertaken by Farm7 (specialists in design research and consultancy) and the Scottish Institute for Residential Child Care (SIRCC). The main focus of the research was to evaluate design interventions aimed at removing 'institutional' approaches to design in the care environment and improving the experience of looked after children. This involved the commissioning of interior design consultants Graven Images in the development and design of South Lanarkshire's residential children's homes. Post-occupancy evaluation of the four residential homes was undertaken with the participation of both looked after children and staff. It was envisaged that this study would contribute to the development of design guidance that will promote a more systematic approach to the design of care environments. This will allow social work and design professionals to draw on a design framework in order to significantly enhance the experience of looked after children and staff

Virtua Walker '87:technostalgia for a walking sim from an alternative past

Virtua Walker ’87 is VR walking sim that makes use of a step-based controller for input. Players view the game world using the Gear VR headset, which they can use to look around. Movement is controlled by walking on the spot, with force sensitive resistors picking up player steps and translating each step into a single step in the game. The game is conceived as a piece of technostalgia from an alternative past, and was created by academic staff at Abertay University as part of Global Game Jam 2017

FASTR: Using Local Structure Tensors as a Similarity Metric

AbstractWe describe a novel structural image descriptor for image registration called the Fractionally Anisotropic Structural Tensor Representation (FASTR), calculated from the local structural tensor (LST). The metric has several characteristics that are advantageous for multi-modality registration, such as not depending on absolute voxel intensities, and being insensitive to slowly varying in- tensity inhomogeneities across the image. This latter property is very useful, since many imaging modalities suffer from such artefacts. Registration accuracy is tested on both computed tomography (CT) to cone-beam CT (CBCT) rigid registration, and CT to magnetic resonance (MR) rigid registration. The performance is compared with Mutual Information (MI) metric and the Self Similarity Context (SSC) descriptor. The results show that, for images with significant intensity inhomogeneity, FASTR produced more accurate results than MI, and faster results than SSC. The results suggest FASTR gives similar benefits in images with intensity inhomogeneity, but at a fraction of the computation and memory demand

Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource-limited settings

BACKGROUND: Despite the advent and increasingly wide availability of antiretroviral therapy, cryptococcal meningitis (CM) remains a significant cause of mortality and morbidity amongst individuals with HIV infection in resource-limited settings. The ideal management of CM remains unclear. The aim of this review is to assess the evidence for deciding on which antifungal regimen to use as well as other modalities of management to utilise especially resource poor settings in order to achieve the best possible outcome and enable an individual with CM to survive their acute illness and benefit from antiretroviral therapy. OBJECTIVES: To determine the most effective initial and consolidation treatment strategy for CM in HIV infected adults. SEARCH STRATEGY: The Cochrane HIV/AIDS group search strategy was used. Key words in the search included, meningitis, cryptococcus neoformans, treatment, trial, human immunodeficiency virus, acquired immunodeficiency syndrome, antifungal agents, amphotericin, flucytosine, fluconazole, azole, lumbar puncture, cerebrospinal fluid (CSF) pressure and acetazolamide. SELECTION CRITERIA: Randomised of HIV-infected adults with a first episode of CM diagnosed on CSF examination, by India ink staining, CSF culture or cryptococcal antigen testing. DATA COLLECTION AND ANALYSIS: Data were extracted using standardised forms and analysed using Rev Man 4.2.7 software. MAIN RESULTS: Six studies are included in the review. Five of the studies compared antifungal treatments and one study addressed lowering intracranial pressure. This study was stopped early due to excess adverse effects. The results of the other five studies as summarised as follows.Mayanja-Kizza 1998 compared fluconazole to fluconazole with 5 flucytosine. The dose of fluconazole used 200mg initially is lower than the recommended initial dose of 400mg. No survival advantage was found with the use of 5 flucytosine in addition to fluconazole.Two studies Brouwer 2004 and van der Horst 1997 compared Amphotericin (AmB) to AmB with 5 flucytosine. Both drugs were given at currently recommended doses for 2 weeks. No survival difference was found at 14 days or at 10 weeks (only recorded in Brouwer 2004). There were significantly more patients with sterile CSF cultures at 14 days in the group that received AmB with flucytosine.Brouwer 2004 compared AmB given alone to AmB given with flucytosine and fluconazole alone or in combination. This was a small study and no differences in mortality were noted between the groups.Bicanic 2008 compared high to standard dose AmB both with flucytosine. There was no difference in mortality between the two groups or adverse events.Leenders 1997 compared standard AmB to liposomal AmB. There was no difference in death rates between the two groups. But there were significantly fewer side effects in the group treated with liposomal AmB. AUTHORS' CONCLUSIONS: The main aim of this review was to determine the best treatment for cryptococcal meningitis in resource-limited settings. In these settings usually only AmB and fluconazole are available. No studies suitable for inclusion in the review were found that compared these two drugs. Therefore we are unable to recommend either treatment as superior to the other. The recommended treatment for CM is a combination of AmB and flucytosine. The optimal dosing of AmB remains unclear. Liposomal AmB is associated with less adverse events than AmB and may be useful in selected patients where resources allow.Future research into the management of cryptococcal meningitis in resource-limited settings should focus on the most effective use of medications that are available in these settings.Flucytosine in combination with AmB leads to faster and increased sterilisation of CSF compared to using AmB alone. As Flucytosine is often not available in developing countries, policy makers and national departments of heath should consider procuring this drug for HIV treatment programmes.Publisher PDFPeer reviewe

Is it really possible to build a bridge between cost-benefit analysis and cost-effectiveness analysis?

Cost-benefit analysis (CBA) is a recognised as the economic evaluation technique that accords most with the underlying principles of standard welfare economic theory. However, due to problems associated with the technique, economists evaluating resources allocation decisions in health care have most often used cost-effective analysis (CEA), in which health benefits are expressed in non-monetary units. As a result, attempts have been made to build a welfare economic bridge between cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). In this paper, we develops these attempts and finds that, while assumptions can be made to facilitate a constant willingness-to-pay per unit of health outcome, these restrictions are highly unrealistic. We develop an impossibility theorem that shows it is not possible to link CBA and CEA if: (i) the axioms of expected utility theory hold; (ii) the quality-adjusted life-year (QALY) model is valid in a welfare economic sense; and (iii) illness affects the ability to enjoy consumption. We conclude that, within a welfare economic framework, it would be unwise to rely on a link between CBA and CEA in economic evaluations

Mark 13 and the return of the shepherd : the narrative logic of Zechariah in Mark

Mark 13 contains numerous interpretative puzzles that continue to generate discussion in contemporary scholarship. One such puzzle is the apparent disparity between a question from the disciples about the destruction of the temple, and the answer by Jesus that seemingly refers to his second coming. Why are the two events conjoined? Additionally, how should one interpret the numerous allusions throughout Mark 13? This study seeks to contribute to the conversation on these and other topics by employing narrative analysis of Mark’s Gospel with special attention to his intertextual allusions to Zechariah. By incorporating intratextual, intertextual, and extratextual data, this study examines the extent to which Zechariah informs Mark’s narrative, with particular focus on Jesus’ speech on the Mount of Olives in Mark 13. Within the parameters of this project, broadly speaking, intratextual data refers to the narrative as Mark presents it; intertextual data refers to Mark’s allusions to external bodies of literature; and extratextual data refers to the codified knowledge of Mark’s cultural encyclopedia. By examining Mark, and particularly Mark 13, with reference to each body of data, I argue that Mark alludes to Zechariah throughout the Gospel in order to express several elements of Jesus’ life and teaching. In particular, I argue that Mark alludes to Zech 13–14 throughout the Gospel in order to describe the tribulations of the disciples and the tribulations of Jerusalem that obtain after “the striking of the shepherd.” In Zech 13–14, the shepherd is struck, the people of God are refined, Jerusalem is attacked, and then God comes with his angels. Mark’s allusions to the latter scenario throughout the Gospel and Mark 13 make sense of Mark’s arrangement of the Olivet Discourse, where, after Jesus has been “stricken,” his disciples suffer, Jerusalem is attacked, and the Son of Man comes with his angels. Recognizing such allusions not only resolves a long-standing interpretative puzzle regarding Mark’s arrangement of the discourse, namely the question as to why he discusses the destruction of Jerusalem and the parousia in a single discourse, but it also contributes to the understanding of Mark’s use of Zechariah in his narration of Jesus’ life and teaching