We apply insights from organizational behavior, psychology, and sociology to make the case that the community in which a firm is embedded is a valuable, rare, inimitable, and nonsubstitutable ...resource that holds potential as a source of sustained competitive advantage. First, we review several key principles of the resource-based view (RBV) and show how they apply to community as a strategic resource, incorporating prior work that simultaneously addresses communities and RBV. Next, we juxtapose pairs of firms in the same industries, comparing those that have embraced this strategy with those that have not, demonstrating the superior sustainability of the firms that consider community as a strategic resource. Finally, we conclude with thoughts as to a future research agenda that allows for an expansion of the concept of resources to further the development of RBV, the firms that apply it, and the communities in which they are embedded. In doing so, we demonstrate how expanding RBV to incorporate the community as strategic resource contributes to managerial theory, research, and practice.
Chitosan, a copolymer of glucosamine and N-acetyl glucosamine, is derived from chitin. Chitin is found in cell walls of crustaceans, fungi, insects and in some algae, microorganisms, and some ...invertebrate animals. Chitosan is emerging as a very important raw material for the synthesis of a wide range of products used for food, medical, pharmaceutical, health care, agriculture, industry, and environmental pollution protection. This review, in line with the focus of this special issue, provides the reader with (1) an overview on different sources of chitin, (2) advances in techniques used to extract chitin and converting it into chitosan, (3) the importance of the inherent characteristics of the chitosan from different sources that makes them suitable for specific applications and, finally, (4) briefly summarizes ways of tailoring chitosan for specific applications. The review also presents the influence of the degree of acetylation (DA) and degree of deacetylation (DDA), molecular weight (Mw) on the physicochemical and biological properties of chitosan, acid-base behavior, biodegradability, solubility, reactivity, among many other properties that determine processability and suitability for specific applications. This is intended to help guide researchers select the right chitosan raw material for their specific applications.
Pain assessment in elderly adults with dementia Hadjistavropoulos, Thomas, Prof; Herr, Keela, Prof; Prkachin, Kenneth M, Prof ...
Lancet neurology,
12/2014, Volume:
13, Issue:
12
Journal Article
Peer reviewed
Summary Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently ...under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. The systematic study of facial expressions through a computerised system has identified core features that are highly specific to the experience of pain, with potential future effects on assessment practices in people with dementia. Various observational–behavioural pain assessment instruments have been reported to be both reliable and valid in individuals with dementia. These techniques need to be interpreted in the context of observer bias, contextual variables, and the overall state of the individual's health and wellbeing.
The current International Association for the Study of Pain (IASP) definition of pain as "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or ...described in terms of such damage" was recommended by the Subcommittee on Taxonomy and adopted by the IASP Council in 1979. This definition has become accepted widely by health care professionals and researchers in the pain field and adopted by several professional, governmental, and nongovernmental organizations, including the World Health Organization. In recent years, some in the field have reasoned that advances in our understanding of pain warrant a reevaluation of the definition and have proposed modifications. Therefore, in 2018, the IASP formed a 14-member, multinational Presidential Task Force comprising individuals with broad expertise in clinical and basic science related to pain, to evaluate the current definition and accompanying note and recommend whether they should be retained or changed. This review provides a synopsis of the critical concepts, the analysis of comments from the IASP membership and public, and the committee's final recommendations for revisions to the definition and notes, which were discussed over a 2-year period. The task force ultimately recommended that the definition of pain be revised to "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage," and that the accompanying notes be updated to a bulleted list that included the etymology. The revised definition and notes were unanimously accepted by the IASP Council early this year.
Both sympathetic and parasympathetic nervous systems are involved in regulating pain states. The activity of these systems seems to become disturbed in states of chronic pain. This disruption in ...autonomic balance can be measured through the assessment of heart rate variability (HRV), that is, the variability of the interval between consecutive heart beats. However, there is yet to be a systematic evaluation of the body of literature concerning HRV across several chronic pain conditions. Moreover, modern meta-analytical techniques have never been used to validate and consolidate the extent to which HRV may be decreased in chronic pain. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement guidelines, this study systematically evaluated and critically appraised the literature concerning HRV in people living with chronic pain. After screening 17,350 sources, 51 studies evaluating HRV in a chronic pain group met the inclusion criteria. Twenty-six moderate-high quality studies were included in quantitative meta-analyses. On average, the quality of studies was moderate. There were 6 frequency-domain and time-domain measures of HRV across a broad range of chronic pain conditions. High heterogeneity aside, pooled results from the meta-analyses reflected a consistent, moderate-to-large effect of decreased high-frequency HRV in chronic pain, implicating a decrease in parasympathetic activation. These effects were heavily influenced by fibromyalgia studies. Future research would benefit from wider use of standardised definitions of measurement, and also investigating the synergistic changes in pain state and HRV throughout the development and implementation of mechanism-based treatments for chronic pain.
Setting. With the ageing of the world's population, any health problem which adversely affects quality of life in older persons becomes increasingly salient. Persistent pain is one of the most ...prevalent health conditions faced by adults of advanced age, and is recognized as a major concern for this segment of the population.
Results. Numerous epidemiologic surveys suggest that pain is most common during the late middle‐aged phase of life (55–65 years) and continues at approximately the same prevalence into older age (65+). This is true regardless of the anatomical site or the pathogenic cause of pain. The one exception appears to be pain associated with degenerative joint disease (e.g., osteoarthritis) which shows an exponential increase until at least 90 years of age. Common age associated conditions like dementia may result in a reduced frequency and intensity of pain. Daily pain is a major risk factor for developing disability and the oldest age cohorts are most vulnerable. Discretionary and higher order physical activities appear most affected, while basic activities of daily living may be modified but are rarely ceased altogether. Similar relationships have been documented for risk of depression and mood disturbance in older persons with persistent pain. Despite such well characterized adverse impacts, pain often remains poorly treated in older persons. This occurs across all health care settings examined (i.e., emergency, acute, outpatient, long‐term care).
Conclusion. Improved knowledge for both health professionals and patients, addressing the current research gaps and expansion of age‐appropriate pain management services will be required to better meet the needs of our rapidly ageing population.
Background
Chronic non‐malignant pain is a disabling condition that results in a reduction in function and quality of life when inadequately managed. Sublingual ketamine has been shown to be ...efficacious for use in chronic pain. Despite its use for decades in chronic non‐malignant pain, there is no published long‐term data on safety, side‐effects or adverse drug reactions.
Aim
The aim of this case‐series is to provide the initial evidence for safety and efficacy in this patient group.
Methods
We present a retrospective review of 29 (n = 29) patients from a metropolitan tertiary pain service who have been receiving sublingual ketamine troches/lozenges between the period of 2012 and 2019. Patients were identified from the outpatient pain clinic, who had been admitted for inpatient subcutaneous ketamine infusions as part of opiate detoxification or management of central sensitisation due to a chronic neuropathic pain syndrome. An initial review was performed to check the patient started taking the ketamine troches. Each of these medical records was reviewed manually to extract information to a datasheet.
Results
There was a wide range of dosages used from 25 to 600 mg in divided doses. The duration of treatment ranged 2−89 months. There was no association with either the dosage or duration of treatment and frequency of side‐effects. There was an overall reduction in the use of opioids, gabapentinoids or benzodiazepines in 59% of patients with 39% having a complete cessation of an analgesic agent. Side‐effects were reported in 24%, but only 7% discontinued the treatment due to the side‐effect (drowsiness). There were no reports of renal impairment, cystitis or hepatotoxicity.
Discussion
This retrospective case‐series has demonstrated that sublingual ketamine is a safe and effective analgesic agent to use in chronic non‐malignant pain management. It is indicated in a variety of chronic pain conditions and has an excellent safety profile, with no association between the frequency in side‐effects and duration of therapy or total daily dosages. The study has also shown that the ‘safe’ dose may be higher than the previous consensus.
The Garden of Earthly Delights Book of Ghazals ranges across time and place in visiting personal as well as historical and even imagined experience. As an abecedarian was once used to teach the ...basics of a thing—say, to recognize an alphabet—Gibson, who has labelled his collection a “scrambled abecedarian,” suggests that all meaning arises out of disorder. However, it is from this disorder that the varied subjects of the poems, controlled by a single form comprising the collection, are shaped into a significance, whether that significance is to record a life at its start, or at its conclusion.   Degas In Degas’ The Absinthe Drinker, the woman in the bar looks so alone and depressed as she stares at her drink. Earlier, she was imagining she would meet someone as she was getting dressed; now, she stares at her drink. There are drunks all around. Everyone drinks absinthe. Lower-class women love it best. They stare at the drink (it’s a poison, literally; they could care less), as they pour   it over sugar to cut its bitterness. They stare and drink. Degas said he viewed women as if through a bathroom keyhole: she gazes into her crystal ball’s green mist—stares, drinks.
In an acute environment pain has potential protective benefits. However when pain becomes chronic this protective effect is lost and the pain becomes an encumbrance. Previously unheralded substances ...are being investigated in an attempt to alleviate the burden of living with chronic pain. Oxytocin, a neuropeptide hormone, is one prospective pharmacotherapeutic agent gaining popularity. Oxytocin has the potential to modulate the pain experience due to its ubiquitous involvement in central and peripheral psychological and physiological processes, and thus offers promise as a therapeutic agent. In this review, we discuss previous effective applications of oxytocin in pain-free clinical populations and its potential use in the modulation of pain experience. We also address the slowly growing body of literature investigating the administration of oxytocin in clinical and experimentally induced pain in order to investigate the potential mechanisms of its reported analgesic actions. We conclude that oxytocin offers a potential novel avenue for modulating the experience of pain, and that further research into this area is required to map its therapeutic benefit.
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