Alfentanil Slightly Increases the Sweating Threshold and Markedly Reduces the Vasoconstriction and Shivering Thresholds

1995 ◽  
Vol 83 (2) ◽  
pp. 293-299. ◽  
Author(s):  
Andrea Kurz ◽  
Janice C. Go ◽  
Daniel I. Sessler ◽  
Klaus Kaer ◽  
Merlin D. Larson ◽  
...  
Keyword(s):  
Skin Temperature ◽  
Major Trauma ◽  
General Anesthetics ◽  
Response Relationship ◽  
Drug Induced ◽  
The Core ◽  
Linear Decrease ◽  
Opioid Administration ◽  
The Individual ◽  
Sweating Threshold

Background Hypothermia is common in surgical patients and victims of major trauma; it also results from environmental exposure and drug abuse. In most cases, hypothermia results largely from drug-induced inhibition of normal thermoregulatory control. Although opioids are given to a variety of patients, the thermoregulatory effects of opioids in humans remain unknown. Accordingly, the hypothesis that opioid administration impairs thermoregulatory control was tested. Methods Eight volunteers were studied, each on 3 days: (1) a target total plasma alfentanil concentration of 100 ng/ml, (2) control (no drug), and (3) a target alfentanil concentration of 300 ng/ml. Each day, skin and core temperatures were increased sufficiently to provoke sweating. Temperatures subsequently were reduced to elicit peripheral vasoconstriction and shivering. Mathematical compensations were made for changes in skin temperature using the established linear cutaneous contributions to control of sweating (10%) and to vasoconstriction and shivering (20%). From the calculated thresholds (core temperatures triggering responses at a designated skin temperature of 34 degrees C) and unbound plasma alfentanil concentrations, the individual concentration-response relationship was determined. The concentration-response relationship for all the volunteers was determined similarly using total alfentanil concentrations. Results In terms of unbound concentration, alfentanil increased the sweating threshold (slope = 0.021 +/- 0.016 degrees C.ng-1.ml; r2 = 0.92 +/- 0.06). Alfentanil also significantly decreased the vasoconstriction (slope = -0.075 +/- 0.067 degrees C.ng-1.ml; r2 = 0.92 +/- 0.07) and shivering thresholds (slope = -0.063 +/- -0.037 degrees C.ng-1.ml; r2 = 0.98 +/- 0.04). In terms of total alfentanil concentration (degrees C.ng-1.ml), the sweating threshold increased according to the equation: threshold (degrees C) = 0.0014[alfentanil] + 37.2 (r2 = 0.33). In contrast, alfentanil produced a linear decrease in the core temperature, triggering vasoconstriction: threshold (degrees C) = -0.0049[alfentanil] + 36.7 (r2 = 0.64). Similarly, alfentanil linearly decreased the shivering threshold: threshold (degrees C) = -0.0057[alfentanil] + 35.9 (r2 = 0.70). Conclusions The observed pattern of thermoregulatory impairment is similar to that produced by most general anesthetics: a slight increase in the sweating threshold and a substantial, linear decrease in the vasoconstriction and shivering thresholds.

Propofol Linearly Reduces the Vasoconstriction and Shivering Thresholds 

1995 ◽  
Vol 82 (5) ◽  
pp. 1169-1180 ◽  
Author(s):  
Takashi Matsukawa ◽  
Andrea Kurz ◽  
Daniel I. Sessler ◽  
Andrew R. Bjorksten ◽  
Benjamin Merrifield ◽  
...  
Keyword(s):  
Skin Temperature ◽  
Core Temperature ◽  
Response Curves ◽  
Target Concentration ◽  
The Core ◽  
Temperature Thresholds ◽  
Cutaneous Temperature ◽  
Response Thresholds ◽  
Temperature Manipulation ◽  
Sweating Threshold

Background Skin temperature is best kept constant when determining response thresholds because both skin and core temperatures contribute to thermoregulatory control. In practice, however, it is difficult to evaluate both warm and cold thresholds while maintaining constant cutaneous temperature. A recent study shows that vasoconstriction and shivering thresholds are a linear function of skin and core temperatures, with skin contributing 20 +/- 6% and 19 +/- 8%, respectively. (Skin temperature has long been known to contribute approximately 10% to the control of sweating). Using these relations, we were able to experimentally manipulate both skin and core temperatures, subsequently compensate for the changes in skin temperature, and finally report the results in terms of calculated core-temperature thresholds at a single-designated skin temperature. Methods Five volunteers were each studied on 4 days: (1) control; (2) a target blood propofol concentration of 2 micrograms/ml; (3) a target concentration of 4 micrograms/ml; and (4) a target concentration of 8 micrograms/ml. On each day, we increased skin and core temperatures sufficiently to provoke sweating. Skin and core temperatures were subsequently reduced to elicit peripheral vasoconstriction and shivering. We mathematically compensated for changes in skin temperature by using the established linear cutaneous contributions to the control of sweating (10%) and to vasoconstriction and shivering (20%). From these calculated core-temperature thresholds (at a designated skin temperature of 35.7 degrees C), the propofol concentration-response curves for the sweating, vasoconstriction, and shivering thresholds were analyzed using linear regression. We validated this new method by comparing the concentration-dependent effects of propofol with those obtained previously with an established model. Results The concentration-response slopes for sweating and vasoconstriction were virtually identical to those reported previously. Propofol significantly decreased the core temperature triggering vasoconstriction (slope = -0.6 +/- 0.1 degrees C.micrograms-1.ml-1; r2 = 0.98 +/- 0.02) and shivering (slope = -0.7 +/- 0.1 degrees C.micrograms -1.ml-1; r2 = 0.95 +/- 0.05). In contrast, increasing the blood propofol concentration increased the sweating threshold only slightly (slope = 0.1 +/- 0.1 degrees C.micrograms -1.ml-1; r2 = 0.46 +/- 0.39). Conclusions Advantages of this new model include its being nearly noninvasive and requiring relatively little core-temperature manipulation. Propofol only slightly alters the sweating threshold, but markedly reduces the vasoconstriction and shivering thresholds. Reductions in the shivering and vasoconstriction thresholds are similar; that is, the vasoconstriction-to-shivering range increases only slightly during anesthesia.

Drug-Induced Agranulocytosis: A Mini Review

2016 ◽  
Vol 2 (1) ◽  
pp. 57-59
Author(s):  
Pavithra D ◽  
Praveen D ◽  
Vijey Aanandhi M
Keyword(s):  
Bone Marrow ◽  
Complete Blood Count ◽  
Genetic Manipulation ◽  
White Blood Cells ◽  
Deep Infection ◽  
Morbidity Rate ◽  
Drug Induced ◽  
Serious Adverse Event ◽  
Mortality And Morbidity ◽  
The Individual

Agranulocytosis is also known to be granulopenia, causing neutropenia in circulating blood streams .The destruction of white blood cells takes place which leads to increase in the infection rate in an individual where immune system of the individual is suppressed. The symptoms includes fever, sore throat, mouth ulcers. These are commonly seen as adverse effects of a particular drug and are prescribed for the common diagnostic test for regular monitoring of complete blood count in an admitted patient. Drug-induced agranulocytosis remains a serious adverse event due to occurrence of severe sepsis with deep infection leading to pneumonia, septicaemia, and septic shock in two/third of the patient. Antibiotics seem to be the major causative weapon for this disorder. Certain drugs mainly anti-thyroid drugs, ticlopidine hydrochloride, spironolactone, clozapine, antileptic drugs (clozapine), non-steroidal anti-inflammatory agents, dipyrone are the potential causes. Bone marrow insufficiency followed by destruction or limited proliferative bone marrow destruction takes place. Chemotherapy is rarely seen as a causative agent for this disorder. Genetic manipulation may also include as one of the reason. Agranulocytosis can be recovered within two weeks but the mortality and morbidity rate during the acute phase seems to be high, appropriate adjuvant treatment with broad-spectrum antibiotics are prerequisites for the management of complicated neutropenia. Drugs that are treated for this are expected to change as a resistant drug to the patient. The pathogenesis of agranulocytosis is not yet known. A comprehensive literature search has been carried out in PubMed, Google Scholar and articles pertaining to drug-induced agranulocytosis were selected for review.

Reply to Connor and Evers (2020): Critique of the Bias of Crowds Model Simply Restates the Model

2020 ◽  
Author(s):  
Keith Payne ◽  
Heidi A. Vuletich ◽  
Kristjen B. Lundberg
Keyword(s):  
Implicit Bias ◽  
Group Level ◽  
Systemic Racism ◽  
Individual Level ◽  
The Core ◽  
Psychological Science ◽  
Implicit Biases ◽  
The Individual

The Bias of Crowds model (Payne, Vuletich, & Lundberg, 2017) argues that implicit bias varies across individuals and across contexts. It is unreliable and weakly associated with behavior at the individual level. But when aggregated to measure context-level effects, the scores become stable and predictive of group-level outcomes. We concluded that the statistical benefits of aggregation are so powerful that researchers should reconceptualize implicit bias as a feature of contexts, and ask new questions about how implicit biases relate to systemic racism. Connor and Evers (2020) critiqued the model, but their critique simply restates the core claims of the model. They agreed that implicit bias varies across individuals and across contexts; that it is unreliable and weakly associated with behavior at the individual level; and that aggregating scores to measure context-level effects makes them more stable and predictive of group-level outcomes. Connor and Evers concluded that implicit bias should be considered to really be noisily measured individual construct because the effects of aggregation are merely statistical. We respond to their specific arguments and then discuss what it means to really be a feature of persons versus situations, and multilevel measurement and theory in psychological science more broadly.

Pathways to Success Through Identity-Based Motivation

2015 ◽  
Author(s):  
Daphna Oyserman
Keyword(s):  
The Self ◽  
The Core ◽  
Very Young Children ◽  
The Future ◽  
Identity Based ◽  
Future Self ◽  
Fidelity Measures ◽  
The Individual ◽  
Taking Action ◽  
Minimal Effort

Everyone can imagine their future self, even very young children, and this future self is usually positive and education-linked. To make progress toward an aspired future or away from a feared future requires people to plan and take action. Unfortunately, most people often start too late and commit minimal effort to ineffective strategies that lead their attention elsewhere. As a result, their high hopes and earnest resolutions often fall short. In Pathways to Success Through Identity-Based Motivation Daphna Oyserman focuses on situational constraints and affordances that trigger or impede taking action. Focusing on when the future-self matters and how to reduce the shortfall between the self that one aspires to become and the outcomes that one actually attains, Oyserman introduces the reader to the core theoretical framework of identity-based motivation (IBM) theory. IBM theory is the prediction that people prefer to act in identity-congruent ways but that the identity-to-behavior link is opaque for a number of reasons (the future feels far away, difficulty of working on goals is misinterpreted, and strategies for attaining goals do not feel identity-congruent). Oyserman's book goes on to also include the stakes and how the importance of education comes into play as it improves the lives of the individual, their family, and their society. The framework of IBM theory and how to achieve it is broken down into three parts: how to translate identity-based motivation into a practical intervention, an outline of the intervention, and empirical evidence that it works. In addition, the book also includes an implementation manual and fidelity measures for educators utilizing this book to intervene for the improvement of academic outcomes.

scholarly journals Antipsychotics in routine treatment are minor contributors to QT prolongation compared to genetics and age

2021 ◽  
pp. 026988112110034
Author(s):  
Leif Hommers ◽  
Maike Scherf-Clavel ◽  
Roberta Stempel ◽  
Julian Roth ◽  
Matthias Falter ◽  
...  
Keyword(s):  
Qt Interval ◽  
Multivariate Regression Analysis ◽  
Cardiac Repolarization ◽  
Qtc Interval ◽  
Serum Concentrations ◽  
Drug Induced ◽  
Individual Level ◽  
Main Determinants ◽  
The Individual ◽  
Polygenic Variation

Background: Drug-induced prolongation of cardiac repolarization limits the treatment with many psychotropic drugs. Recently, the contribution of polygenic variation to the individual duration of the QT interval was identified. Aims: To explore the interaction between antipsychotic drugs and the individual polygenic influence on the QT interval. Methods: Retrospective analysis of clinical and genotype data of 804 psychiatric inpatients diagnosed with a psychotic disorder. The individual polygenic influence on the QT interval was calculated according to the method of Arking et al. Results: Linear regression modelling showed a significant association of the individual polygenic QT interval score (ßstd = 0.176, p < 0.001) and age (ßstd = 0.139, p < 0.001) with the QTc interval corrected according to Fridericia’s formula. Sex showed a nominal trend towards significance (ßstd = 0.064, p = 0.064). No association was observed for the number of QT prolonging drugs according to AZCERT taken. Subsample analysis ( n = 588) showed a significant association of potassium serum concentrations with the QTc interval (ßstd = −0.104, p = 0.010). Haloperidol serum concentrations were associated with the QTc interval only in single medication analysis ( n = 26, ßstd = 0.101, p = 0.004), but not in multivariate regression analysis. No association was observed for aripiprazole, clozapine, quetiapine and perazine, while olanzapine and the sum of risperidone and its metabolite showed a negative association. Conclusions: Individual genetic factors and age are main determinants of the QT interval. Antipsychotic drug serum concentrations within the therapeutic range contribute to QTc prolongation on an individual level.

scholarly journals Temperature Monitoring and Perioperative Thermoregulation

2008 ◽  
Vol 109 (2) ◽  
pp. 318-338 ◽  
Author(s):  
Daniel I. Sessler ◽  
David S. Warner ◽  
Mark A. Warner
Keyword(s):  
Body Temperature ◽  
General Anesthesia ◽  
Core Temperature ◽  
Core Body Temperature ◽  
Neuraxial Anesthesia ◽  
General Anesthetics ◽  
The Core ◽  
Core Body ◽  
Dose Dependent ◽  
Body Heat

Most clinically available thermometers accurately report the temperature of whatever tissue is being measured. The difficulty is that no reliably core-temperature-measuring sites are completely noninvasive and easy to use-especially in patients not undergoing general anesthesia. Nonetheless, temperature can be reliably measured in most patients. Body temperature should be measured in patients undergoing general anesthesia exceeding 30 min in duration and in patients undergoing major operations during neuraxial anesthesia. Core body temperature is normally tightly regulated. All general anesthetics produce a profound dose-dependent reduction in the core temperature, triggering cold defenses, including arteriovenous shunt vasoconstriction and shivering. Anesthetic-induced impairment of normal thermoregulatory control, with the resulting core-to-peripheral redistribution of body heat, is the primary cause of hypothermia in most patients. Neuraxial anesthesia also impairs thermoregulatory control, although to a lesser extent than does general anesthesia. Prolonged epidural analgesia is associated with hyperthermia whose cause remains unknown.

scholarly journals Cognitive–behavioural therapy with older people

2007 ◽  
Vol 13 (2) ◽  
pp. 111-118 ◽  
Author(s):  
Ceri Evans
Keyword(s):  
Older People ◽  
Effective Treatment ◽  
Psychiatric Disorders ◽  
Cognitive Behavioural Therapy ◽  
Historical Context ◽  
Behavioural Therapy ◽  
Age Group ◽  
The Core ◽  
Cognitive Behavioural ◽  
The Individual

Cognitive–behavioural therapy (CBT) is an effective treatment for a number of psychiatric disorders in adults of all ages. With the proportion of the population aged 65 or over increasing steadily, it is important to be aware of how the CBT needs of this age group can be best met. This article provides an overview of CBT and the historical context of using it with older people. Although an understanding of the individual, irrespective of age, is at the core of CBT, potential modifications to the procedure and content aimed at optimising its effectiveness for older people are discussed.

ЦЕННОСТИ И СМЫСЛЫ НЕНАСИЛИЯ В ПОЛИТИЧЕСКОМ ПРОТЕСТЕ

2021 ◽  
Vol 15 (4) ◽  
pp. 58
Author(s):  
Л. Ю. Логунова ◽  
Е. А. Маженина
Keyword(s):  
Political Culture ◽  
New Left ◽  
Political Protest ◽  
Self Awareness ◽  
Sociological Study ◽  
The Core ◽  
Long Term Study ◽  
History Of ◽  
The Individual ◽  
Left Movement

The article presents the results of a long-term study of protest as a cultural phenomenon, the transformation of values, realized in the activities of the best people of the planet and their followers. These values have absorbed the experience of many generations and the behavior of people defending the rights of an individual to dignity, equality before the law, fair attitude, freedom of thought. In the history of the development of political thought, values have formed that constitute the core of civil culture. The genesis of the birth of the nucleus of civil culture from the thinkers of Antiquity, ideologists of nonviolent resistance, leaders of the French bourgeois revolution, activists of the “new left” movement to the protests of our time is shown. The basis for updating the protection of these values is the socio-political situation, characterized by the divergence of interests of civil society and ruling political groups. The values of the core of civil culture (freedom of speech, freedom of conscience, freedom of assembly, human rights) acquire an acute urgency in situations of power crisis. This is the time of the birth of new values that will mobilize new generations of protesters. Protest, as an act of protecting the values of the individual, is a measure of the level of development of political culture in the state. The protest — it's not just a mass exit of dissent on the area. This is an indicator of the level of self-awareness of citizens and the development of the political culture of society. The symbols of political protest actions are a special text that expresses the meanings of values. The authors present the results of a sociological study, which used comparative, value-semantic, interpretive approaches, studied the meanings and values of political protests of the 20th — early 19th centuries, analyzed visual and publicistic evidence of protest actions: photo and video materials, publications in the press.

Structuring the Wider Environment and the DBT Team

2018 ◽  
pp. 216-234
Author(s):  
Michaela A. Swales ◽  
Christine Dunkley
Keyword(s):  
Clinical Experience ◽  
Implementation Research ◽  
Dialectical Tensions ◽  
Behaviour Therapy ◽  
Dialectical Behaviour Therapy ◽  
The Core ◽  
Clinical Literature ◽  
Consultation Team ◽  
The Individual

The role of the dialectical behaviour therapy (DBT) team lead is rarely discussed in the DBT academic or clinical literature. However, much implementation research and clinical experience in training and supporting teams new to DBT indicates the importance of the team lead to the correct and efficient functioning of the team itself. This chapter outlines the role of the team lead in relation to two of the functions of DBT; structuring the environment, and enhancing therapists’ capabilities and motivation. It outlines and discusses the core tasks of each of these functions for the team lead. Additionally, it describes the skills and strategies team leads need to learn and deploy to their team in the individual therapeutic and consultation team settings. Lastly, it outlines common dialectical tensions that can arise for team leads, and offers strategies for their management.

scholarly journals THE IMPLEMENTATION OF INDONESIA’S PUBLIC POLICY TO IMMIGRATION SELECTIVE POLICY BASED ON LAW NO. 6 OF 2011

2018 ◽  
Vol 1 (2) ◽  
pp. 169-178
Author(s):  
Muhammad Azzam Alfarizi
Keyword(s):  
Public Policy ◽  
Human Rights ◽  
Service Needs ◽  
Human Beings ◽  
The Third ◽  
The Core ◽  
The Government ◽  
The Individual ◽  
The Right ◽  
Service Standards

The inherent right of the individual is an affirmation that human beings must be treated properly and civilized and must be respected, as the sounding of the second precept is: "Just and Civilized Humanity". Human rights are manifestations of the third principle, namely: "Indonesian Unity". If all rights are fulfilled, reciprocally the unity and integrity will be created. Rights are also protected and upheld as is the agreement of the fourth precepts that reads: "Democracy Led by Wisdom in Consultation / Representation". Human Rights also recognizes the right of every person for the honor and protection of human dignity and dignity, which is in accordance with the fifth precepts which read: "Social Justice for All Indonesian People" PASTI Values ​​which are the core values ​​of the Ministry of Law and Human Rights which is an acronym of Professional, Accountable, Synergistic, Transparent and Innovative is an expression of the performance of the immigration apparatus in providing human rights based services. If these values ​​are in line with the values ​​contained in Pancasila, the criteria for evaluating human rights-based public services are based on the accessibility and availability of facilities; the availability of alert officers and compliance of officials, employees, and implementers of Service Standards for each service area will be easily achieved. It is fitting that immigration personnel in providing services must be in accordance with the principles of human rights-based services and in harmony with the Pancasila philosophy. This is as an endeavor in fulfilling service needs in accordance with the mandate of the 1945 Constitution, provisions of applicable laws and human rights principles for every citizen and population for services provided by the government in this case Immigration.  

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