Ethics of pain management in infants and older children

2021 ◽  
pp. 649-659
Author(s):  
Kenneth D. Craig ◽  
Adam Shriver
Keyword(s):  
Healthcare Professionals ◽  
Cognitive Biases ◽  
Cost Effective ◽  
Ethical Practice ◽  
Older Children ◽  
Effective Interventions ◽  
Assessment And Treatment ◽  
Clinically Significant ◽  
Biopsychosocial Model Of Pain ◽  
And Control

Moderate-to-severe pain arising from injuries, diseases, and medical procedures is inevitable during infancy and childhood, yet pain is often unrecognized, ignored, poorly assessed, underestimated, untreated, or poorly treated. Ineffective care for clinically significant acute and chronic pain typically reflects a lack of scientific understanding, inadequate treatments, and insufficient education of healthcare professionals in evidence-based care. Infants and older children warrant special care. Despite a moral responsibility to prevent and ameliorate pain and suffering in children, there is substantial evidence of systemic and individual failures to prevent and control their pain, despite known, evidence-supported, and cost-effective interventions in both the developing and developed world. Instructive perspectives from the philosophy of ethics focus on the consequences of pain, delineating intrinsically bad and destructive features, the intentions of parties responsible for inflicting and relieving pain, specific imperatives addressing human rights concerning inflicting and relieving pain, and characteristics of virtuous people committed to ethical caring. We address ethical implications of the inadequacies of our understanding and control of pediatric pain, as well as barriers preventing important research in the field. Problematic issues concern dominance of biomedical care, rather than care based on a biopsychosocial model of pain, and the human capacity for cognitive biases in interactions with other people. Ethical obligations of healthcare professionals are addressed. Attention is directed to an online training resource for ethical practice in caring for children’s pain. Specific issues are also addressed, including clinician competence, free and informed consent and assent confidentiality, and assessment and treatment choice.

scholarly journals Prevalence of Vitamin D Deficiency and Its Relationship with Clinical Outcomes in Patients with Fibromyalgia: a Systematic Review of the Literature

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Omar M. E. Ali
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Patient Flow ◽  
Controlled Trial ◽  
Cost Effective ◽  
Therapeutic Benefit ◽  
Vitamin D Supplementation ◽  
Effective Interventions ◽  
Randomised Controlled ◽  
And Control

Abstract Fibromyalgia is a debilitating chronic condition which poses a therapeutic challenge to the clinician. With a large backlog in patient flow subsequent to the COVID-19 pandemic and rising numbers of patients with post-acute sequelae of COVID-19 (PASC) presenting with fibromyalgia-like clinical features, there is an increasingly pressing need to identify broad cost-effective interventions. Low levels of vitamin D have previously been reported in patients with fibromyalgia, though any causative link has been difficult to establish. A systematic literature review on the association between vitamin D deficiency and fibromyalgia was performed examining retrospective evidence both for and against an association between vitamin D deficiency (VDD) and fibromyalgia and evaluating the therapeutic benefit from supplementation. A group of six studies were selected based on relevance, use of controls, quality of research and citations. Four primary studies assessing the prevalence of VDD in fibromyalgia patients versus controls were evaluated with a total 3,496 subjects. Three included females only and one larger study assessed males. Two (n = 313) concluded the presence of a statistically significant association, and two (n = 161) found none. Two randomised controlled trials assessing the effect of vitamin D supplementation in a total of 80 subjects found conflicting results, with pain reduction in one and none in the other. It is likely there exists an association between VDD deficiency and fibromyalgia in a large subset of patients, although establishing primary causation is difficult. There is a need for larger randomised controlled trial designs with more effective comparison with healthy subjects and control for confounding factors. Given VDD is a major problem in the general population, we recommend supplementation be recommended by healthcare professionals to fibromyalgia patients for the purpose of maintaining bone health given their potentially increased susceptibility to developing deficiency and its sequelae.

scholarly journals Transmission dynamics and control of Sporotrichosis in domestic felines

2021 ◽  
Author(s):  
Aurélio de Aquino Araújo ◽  
Cláudia Codeço ◽  
Dayvison F S Freitas ◽  
Priscila M de Macedo ◽  
Sandro A Pereira ◽  
...  
Keyword(s):  
Positive Impact ◽  
Control Strategies ◽  
Public Health Problem ◽  
Cost Effective ◽  
Mass Treatment ◽  
Sporothrix Brasiliensis ◽  
Effective Interventions ◽  
Dynamics And Control ◽  
Reduction Methods ◽  
And Control

Sporotrichosis is a subcutaneous mycosis with a global distribution, also known as “rose gardener’s disease”. Brazil is experiencing a rapid spread of the zoonotic transmission of of Sporothrix brasiliensis, the main etiological agent of this disease in this country, affecting domestic felines. Cost-effective interventions need to be developed to control this emergent public health problem. To allow for the comparison of alternative control strategies, we propose in this paper, a mathematical model representing the transmission of S. brasiliensis among cats, stratified by age and sex. Analytical properties of the model are derived and simulations show possible strategies for reducing the endemic levels of the disease in the cat population, with a positive impact on human health. The scenarios included mass treatment of infected cats and mass implementation of contact reduction practices, such as neutering. The results indicate that mass treatment can reduce substantially the disease prevalence, and this effect is potentialized when combined with neutering or other contact-reduction interventions. On the other hand, contact-reduction methods alone are not sufficient to reduce prevalence.

Situational Strategic Awareness Monitoring Surveillance System–Microcomputer and Microcomputer Clustering used for Intelligent, Economical, Scalable, and Deployable Approach for Safeguarding Materials

2020 ◽  
Vol 2020 (3) ◽  
pp. 60408-1-60408-10
Author(s):  
Kenly Maldonado ◽  
Steve Simske
Keyword(s):  
Surveillance System ◽  
Cost Effective ◽  
Government Agencies ◽  
Electronic Systems ◽  
Time Data ◽  
Potential Threat ◽  
Intelligent Surveillance ◽  
World Markets ◽  
Programming Software ◽  
And Control

The principal objective of this research is to create a system that is quickly deployable, scalable, adaptable, and intelligent and provides cost-effective surveillance, both locally and globally. The intelligent surveillance system should be capable of rapid implementation to track (monitor) sensitive materials, i.e., radioactive or weapons stockpiles and person(s) within rooms, buildings, and/or areas in order to predict potential incidents proactively (versus reactively) through intelligence, locally and globally. The system will incorporate a combination of electronic systems that include commercial and modifiable off-the-shelf microcomputers to create a microcomputer cluster which acts as a mini supercomputer which leverages real-time data feed if a potential threat is present. Through programming, software, and intelligence (artificial intelligence, machine learning, and neural networks), the system should be capable of monitoring, tracking, and warning (communicating) the system observer operations (command and control) within a few minutes when sensitive materials are at potential risk for loss. The potential customer is government agencies looking to control sensitive materials and/or items in developing world markets intelligently, economically, and quickly.

Role of Rasayana in Prevention of COVID-19 - A Review

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 716-722
Author(s):  
Sneha Dhakite ◽  
Sadhana Misar Wajpeyi
Keyword(s):  
Immune System ◽  
Respiratory System ◽  
Viral Infections ◽  
Cost Effective ◽  
The Body ◽  
Healthy Life ◽  
Vital Functions ◽  
Healthy Life Style ◽  
And Control

The “Coronavirus disease 19 (COVID-19)” is caused by “Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)”, a newly discovered member of the Coronaviridae family of viruses which is a highly communicable. There is no effective medical treatment till date for Coronavirus disease hence prevention is the best way to keep disease away. Rasayana proved to be highly efficacious and cost effective for the Prevention and Control of viral infections when vaccines and standard therapies are lacking. Rasayana Chikitsa is one of the eight branches of Ashtanga Ayurveda which helps to maintain healthy life style. Rasayana improves immunity and performs many vital functions of human body. Vyadhikshamatva that is immune mechanism of the body is involved in Prevention of the occurrence of a new disease and it also decreases the virulence and progression of an existing disease. In COVID-19 the Respiratory system mainly get affected which is evident from its symptoms like cold, cough and breathlessness. Here the drugs help in enhancing immune system and strengthening functions of Respiratory system can be useful. For this purpose, the Rasayana like Chyavanprasha, Agastya Haritaki, Pippali Rasayana, Guduchi, Yashtimadhu, Haridra, Ashwagandha, Tulsi are used. Rasayana working on Respiratory system are best for Prevention of Coronavirus and boosting immune system. Rasayana Chikitsa can be effective in the Prevention as well as reducing symptoms of COVID-19.

A cost-effective preventative approach to potentially save lives in the coronavirus pandemic, jointly using Vitamin D, Curcumin, and Vitamin C. Authors Bakare T A and Soar J S

2020 ◽  
Author(s):  
Jagjit S Soar
Keyword(s):  
Vitamin D ◽  
Vitamin C ◽  
Cost Effective ◽  
Risk Groups ◽  
The Elderly ◽  
Pharmaceutical Drugs ◽  
Over The Counter ◽  
Literature Searches ◽  
Pharmaceutical Agents ◽  
And Control

he current COVID-19 pandemic now believed to be based on the mutation of the SARS-CoV virus (first reported in 2002) to SARS-CoV-2 emerging in 2019, is naturally causing extreme worry and concern around the world with sometimes mixed and incoherent messages on how to deal with it. There is a plethora of information from previous epidemics caused by other coronaviruses such as severe acute respiratory syndrome, SARS (2002) and Middle East respiratory syndrome MERS (2012) from which we can extrapolate guidance on how to deal with the current pandemic. In the current absence of specific pharmaceutical agents, we propose assessing the extended tools that we already possess in our biological armoury to combat, prevent and control the spread of this virus. Using a set of precise criteria to locate such possible contenders, we conducted literature searches to find compounds that met these criteria. We have now reduced this to a shortlist of three agents that may be the best candidates. We propose vitamin C, vitamin D and Curcumin fit our criteria well. These compounds are widely available to the general public. They are available online and over-the-counter as supplements. Otherwise healthy individuals are safely able to self-administer these agents as a prophylactic to protect themselves and to enhance their immune response. This would be especially desirable for the elderly and at risk groups. These agents can also be used as adjunct therapy, particularly for those who may have early symptoms. This preventative therapy could be implemented whilst awaiting specific pharmaceutical drugs to emerge as a treatment for COVID-19. Our suggested compounds are a highly cost-effective way to potentially reduce the mortality that is regretfully mounting as a result of COVID-19 infection. The biological mode of action and the dosing of these compounds are summarised.

Disorders of Development

2010 ◽  
pp. 551-574
Author(s):  
V. Mark Durand
Keyword(s):  
Pervasive Developmental Disorders ◽  
Developmental Disorders ◽  
Early Adulthood ◽  
Learning Disorders ◽  
Future Research ◽  
Hyperactivity Disorder ◽  
Asperger Disorder ◽  
Oppositional Defiant ◽  
Assessment And Treatment ◽  
Clinically Significant

Disorders of development include a range of problems first evidenced in childhood. Although most disorders have their origins in childhood, a few fully express themselves before early adulthood. This chapter describes the nature, assessment, and treatment of the more common disorders that are revealed in a clinically significant way during a child’s developing years. The disorders of development affect a range of functioning, from single skills deficits to more pervasive problems that negatively impact a child’s ability to function. Included is coverage of several disorders usually diagnosed first in infancy, childhood, or adolescence, including attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, learning disorders, communication and related disorders, pervasive developmental disorders (including autistic disorder and Asperger disorder), and intellectual disabilities. Recommendations for future research on the potential for advancing knowledge regarding spectrums within some of these disorders, as well as recommendations for treatment, are outlined.

scholarly journals 201 Reducing Noise Pollution on a Surgical Ward

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Shah
Keyword(s):  
Healthcare Professionals ◽  
Noise Pollution ◽  
Positive Role ◽  
Low Resource ◽  
Admission Rates ◽  
Quality Patient Care ◽  
Surgical Ward ◽  
Control Ward ◽  
Icu Psychosis ◽  
And Control

Abstract Noise pollution in surgical wards negatively influence the wellbeing of patients and healthcare professionals. In addition to disrupting sleep and impairing communication, recognised patient consequences include increased pain, increased re-admission rates and post-ICU psychosis. Ambient white-noise machines, sound-absorbing ceilings and retractable screens are purported as noise pollution reducing strategies (NPRS). These are expensive and impractical. We investigated the capacity of various low resource NPRSs. Noise was measured using “Sound Meter” app at four sites on two identical surgical wards. Ward A and B were designated as study and control ward, respectively. Measurements were taken at three time points (9am, 11am, 3pm) every day during a week. NPRSs were then implemented in ward A and data collection repeated. Prior to intervention there was no difference in noise between ward A and ward B (83dB and 87dB respectively, p > 0.05). After intervention, ward A was significantly quieter than ward B (64dB and 85dB respectively, p < 0.05). Restructuring ward environments presents several challenges. However, low resource interventions can have a positive role in reducing noise pollution. As hospitals become busier with resumption of normal services post-COVID-19, staff should be considerate of noise pollution in order to create an environment conducive to high quality patient care.

scholarly journals “PrEP”ing for a PrEP demonstration project: understanding PrEP knowledge and attitudes among cisgender women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elizabeth C. Pasipanodya ◽  
Jamila Stockman ◽  
Thupten Phuntsog ◽  
Sheldon Morris ◽  
Christina Psaros ◽  
...  
Keyword(s):  
Los Angeles ◽  
Focus Groups ◽  
Knowledge And Attitudes ◽  
Women Living With Hiv ◽  
Effective Interventions ◽  
Hiv Serostatus ◽  
Prep Awareness ◽  
Exposure Prophylaxis ◽  
Competing Priorities ◽  
And Control

Abstract Background Prior to implementing a pre-exposure prophylaxis (PrEP) demonstration study, we sought to explore cisgender women’s experiences with HIV prevention, PrEP knowledge and attitudes, and anticipated barriers and facilitators for PrEP uptake and adherence in Southern California. Methods Three focus groups were held with cisgender women of mixed HIV serostatus in San Diego and Los Angeles between November 2015 and January 2016. Women were recruited through local testing sites, community-based organizations, and social media. Focus groups were audio-recorded and transcripts were analyzed using thematic analysis. Results Twenty-two women participated in focus groups, with median age 44 (IQR 30–53) and 6 identifying as non-Hispanic Black, 7 non-Hispanic White, 8 Latina and 1 mixed race. Despite limited prior PrEP knowledge and no PrEP experience, participants expressed interest in taking PrEP. Anticipated benefits were freedom from worry about HIV and control over sexual health; however, these were tempered by concerns including the possibility of increased HIV risk behaviors and potential side effects. Cisgender women reported potential barriers to PrEP uptake and adherence barriers, like competing priorities and poor PrEP access. Conversely, PrEP facilitators included utilizing practical tools such as phone apps and pill boxes as well as receiving encouragement from loved ones and support from other cisgender women on PrEP, women living with HIV and their medical providers. Conclusions Although PrEP awareness was low, participants recognized the importance of PrEP and ways to facilitate adherence. Exploring perspectives of cisgender women is integral to developing effective interventions to support PrEP uptake and adherence for women at elevated risk for HIV.

scholarly journals Experimental Strain Measurement Approach Using Fiber Bragg Grating Sensors for Monitoring of Railway Switches and Crossings

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3639
Author(s):  
Abdelfateh Kerrouche ◽  
Taoufik Najeh ◽  
Pablo Jaen-Sola
Keyword(s):  
Fiber Bragg Grating ◽  
Experimental Tests ◽  
Cost Effective ◽  
Measuring Method ◽  
Bragg Grating ◽  
Railway Network ◽  
System Failures ◽  
Railway Infrastructure ◽  
Train Speed ◽  
And Control

Railway infrastructure plays a major role in providing the most cost-effective way to transport freight and passengers. The increase in train speed, traffic growth, heavier axles, and harsh environments make railway assets susceptible to degradation and failure. Railway switches and crossings (S&C) are a key element in any railway network, providing flexible traffic for trains to switch between tracks (through or turnout direction). S&C systems have complex structures, with many components, such as crossing parts, frogs, switchblades, and point machines. Many technologies (e.g., electrical, mechanical, and electronic devices) are used to operate and control S&C. These S&C systems are subject to failures and malfunctions that can cause delays, traffic disruptions, and even deadly accidents. Suitable field-based monitoring techniques to deal with fault detection in railway S&C systems are sought after. Wear is the major cause of S&C system failures. A novel measuring method to monitor excessive wear on the frog, as part of S&C, based on fiber Bragg grating (FBG) optical fiber sensors, is discussed in this paper. The developed solution is based on FBG sensors measuring the strain profile of the frog of S&C to determine wear size. A numerical model of a 3D prototype was developed through the finite element method, to define loading testing conditions, as well as for comparison with experimental tests. The sensors were examined under periodic and controlled loading tests. Results of this pilot study, based on simulation and laboratory tests, have shown a correlation for the static load. It was shown that the results of the experimental and the numerical studies were in good agreement.

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