Patients have rated severe nausea to be worse than postoperative pain. The overall incidence of postoperative nausea and vomiting (PONV) is 25%-30% and can lead to delayed discharge and unanticipated ...hospital admission. After outpatient surgery, the overall incidence of postdischarge nausea has been reported to be 17% and of vomiting 8%, higher than nausea and vomiting reported during the procedure or recovery. Patients who experienced postdischarge nausea and vomiting (PDNV) were unable to resume normal daily activities as quickly. This paper addresses the frequency, pathophysiology and patient perception of PONV and PDNV and reviews antiemetics and adjunctive medications used for the prevention, management, and treatment of PONV and PDNV. For each, the indication, mechanism of action, adverse effects, drug interactions, and implications for oral surgery and outpatient sedation are provided. Because many antiemetics are available for prevention, management, and treatment of PONV and PDNV, optimal medication choices are important for each procedure and patient.
Sampling errors in eddy correlation flux measurements arise from the small number of large eddies that dominate the flux during typical sampling periods. Several methods to estimate sampling, or ...random error in flux measurements, have been published. These methods are compared to a more statistically rigorous method which calculates the variance of a covariance when the two variables in the covariance are auto‐ and cross‐correlated. Comparisons are offered between the various methods. Compared to previously published methods, error estimates from this technique were 20 to 25% higher because of the incorporation of additional terms in the estimate of the variance. This new approach is then applied to define the random error component of representative eddy correlation flux measurements of momentum, sensible and latent heat, carbon dioxide, and ozone from five field studies, three over agricultural crops (corn, soybean, and pasture), and two from towers over forests (deciduous and mixed). The mean normalized error for each type of flux measurement over the five studies ranged from 12% for sensible heat flux to 31% for ozone flux. There were not large or significant differences between random errors for fluxes measured over crops versus those measured over forests. The effects of stability, flux magnitude, and wind speed on measurement error are discussed.
In this paper, we describe the latest version of the dry deposition inferential model, which is used to estimate the deposition velocities (Vd) for SO2, O3, HNO3, and particles with diameters less ...than 2 μm. The dry deposition networks operated by the National Oceanic and Atmospheric Administration (NOAA) and the Environmental Protection Agency (EPA) use this model to estimate dry deposition on a weekly basis. This model uses a multilayer approach, discretizing the vegetated canopy into 20 layers. The use of canopy radiative transfer and simple wind profile models allows for estimates of stomatal (rs) and leaf boundary layer (rb) resistances to be determined at each layer in the plant canopy for both sunlit and shaded leaves. The effect of temperature, water stress, and vapor pressure deficits on the stomatal resistance (rs) have been included. Comparisons of modeled deposition velocities are made with extensive direct measurements performed at three different locations with different crops. The field experiment is discussed in some detail. Overall, modeled O3 deposition velocities are in good agreement with measured values with the average mean bias for all surfaces of the order of 0.01 cm/s or less. For SO2, mean biases range from −0.05 for corn to 0.15 cm/s for soybeans, while for HNO3, they range from 0.09 for corn to 0.47 cm/s for pasture.
Pain management is important when dealing with pediatric dental patients. The use of local anesthetics can be especially challenging for children taking psychotropic medications. The purpose of this ...paper was to identify pertinent information regarding drug interactions between vasoconstrictor/local anesthetic combinations and medications for the management of psychiatric or behavior disorders in children. Many of the reported interactions are controversial, largely theoretical with very limited clinical evidence, and not well defined. However, when considering the potential for significant increased blood pressure when local anesthesia containing a vasoconstrictor is used, a thorough under standing of the pharmacological actions of medications used to treat psychiatric or behavioral disorders and vasoconstrictors can help dental professionals minimize the potential risk of drug interactions in their practice.
Tramadol‐Warfarin Interaction Sabbe, Jonell R.; Sims, Pamela J.; Sims, Marion H.
Pharmacotherapy,
July‐August 1998, Letnik:
18, Številka:
4
Journal Article
Recenzirano
A 61‐year‐old women receiving warfarin after mitral valve replacement experienced extensive ecchymoses after starting tramadol therapy. Laboratory values revealed critical elevations of prothrombin ...time and international normalized ratio. The patient's coagulation values returned to acceptable levels after discontinuing tramadol and temporarily stopping warfarin. The mechanism for this interaction is unknown. Practitioners should be aware of the possibility of such a interaction and exercise caution when tramadol is prescribed for a patient receiving warfarin.
Sickle cell disease was first reported in 1910 by J. Herrick, and since then, various associated conditions and complications have been described. Sickle cell disease is a hereditary disorder ...characterized by abnormality of the hemoglobin in the red blood cell. During periods of decreased oxygen tension in the red blood cell's environment, the abnormal hemoglobin within the red blood cell polymerizes and causes it to assume its sickled shaped. This morphological change and its associated physiological changes drastically reduce the ability of red blood cells to navigate and deliver oxygen throughout the body.
Sickle cell disease is a significant health problem affecting 1 in 400 African-Americans in the United States. One in 10 African-Americans in the United States has sickle cell trait. A variety of hemoglobinapathies are classified as sickle cell disease. Variants that simultaneously occur with hemoglobin S in high frequency are hemoglobins C and β Thalassemia, and less frequently hemoglobin E. Sickle cell disease is characterized by chronic hemolytic anemia, end-organ damage, a heightened susceptibility to infections, and intermittent episodes of vascular occlusion causing both acute and chronic pain. Neurological symptoms are frequent in patients diagnosed with sickle cell disease.
Considering the vaso-occlusive nature of sickle cell disease, the potential for auditory damage is not unexpected. However, the incidence of subjective hearing impairment among sickle cell anemia subjects is very low; therefore, the interest in hearing loss associated with the disease is not in its symptomatology, but in its pathogenesis. The relationship between sickle cell anemia and hearing loss is documented, but little is known about the relationship. Numerous investigations have assessed peripheral auditory sensitivity with a wide disparity of results.
In the article, we will discuss:
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The genetic characteristics and the pathophysiology of sickle cell disease;
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The prevalence and predominate site of hearing loss and/or auditory dysfunction during sickle cell crisis and with the disease under control (non-crisis);
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A model for appropriate audiological assessment and treatment of sickle cell disease patients, including published results of investigations utilizing this model.
In view of the diversity of results and speculative etiology presented here and in the literature, the relationship between sickle cell anemia, auditory sensitivity, and auditory function warrants additional investigation.
As a result of this activity, the participant will read descriptions of the genetic and pathophysiological characteristics of sickle cell disease. The participant will examine evidence of the prevalence of hearing loss and auditory dysfunction in the sickle cell population, as well as the overall hearing health risk for sickle cell patients in comparison to the risk for the normal hemoglobin population. The participant will examine a model for appropriate audiological assessment of treatment of patients with sickle cell disease.
The organization of the chapters in a format consistent with the third edition, using the major headings of Clinical Pharmacokinetics, Pharmacodynamics, Clinical Application of Pharmacokinetic Data, ...Analytical Methods, a Prospectus and Case Studies, provides the reader a comprehensive view of therapeutic drug monitoring.
We evaluated the mismatch negativity (MMN) event-related potential (ERP) in normal and aphasic adults to tone and speech stimuli to determine aphasic patients' auditory discrimination and the ...relationship between MMN measures and severity of aphasia. MMNs were present in 89% of normal subjects and 79% of aphasic subjects to tone stimuli. MMNs were present in 100% of normal subjects and 54% of aphasic subjects to speech stimuli. The duration of the MMN ERP to speech stimuli was significantly related to severity of aphasia on the Western Aphasia Battery, Porch Index of Communicative Ability, and the Token Test. Thus, not all aphasic people show an early, preconscious orientation response to tone and speech stimuli. However, the duration of this response, when present, to speech stimuli appears to be related to the severity of aphasia.
We describe the latest version of the dry deposition inferential model, which is used to estimate the deposition velocities (V(d)) for SO2, O3, HNO3, and particles with diameters less than 2 microns. ...The dry deposition networks operated by the NOAA and the EPA use this model to estimate dry deposition on a weekly basis. This model uses a multilayer approach, discretizing the vegetated canopy into 20 layers. The use of canopy radiative transfer and simple wind profile models allows estimates of stomatal (r(s)) and leaf boundary layer (r(b)) resistances to be determined at each layer in the plant canopy for both sunlit and shaded leaves. The effects of temperature, water stress, and vapor pressure deficits on r(s) are included. Comparisons of modeled deposition velocities are made with extensive direct measurements performed at three different locations with different crops. The field experiment is discussed in some detail. Overall, modeled O3 deposition velocities are in good agreement with measured values with the average mean bias for all surfaces of the order of 0.01 cm/s or less. For SO2, mean biases range from -0.05 for corn to 0.15 cm/s for soybeans, while for HNO3, they range from 0.09 for corn to 0.47 cm/s for pasture. (Author)
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