Clinical Pharmacology of Fentanyl in Infants and Children

Fentanyl is a systemic opioid related to the phenylpiperidines, it is used in anaesthetic practice and in analgesia and the analgesic effect is about 100 times higher than that of morphine. Fentanyl is highly lipid soluble, rapidly crosses the blood-brain-barrier, and fentanyl concentrations rapidly decline in plasma and cerebrospinal fluid. Fentanyl causes respiratory depression and decreases the heart rate through vagal activation. Fentanyl may be administered intravenously, orally, by transdermal, intranasal or by buccal application and the oral bioavailability is poor. In infants, fentanyl is given for short term use, sustained use, and during therapeutic hypothermia. In children, fentanyl is given intravenously, by transdermal application, or by buccal administration and the fentanyl dose varies with the child age and body-weight. Fentanyl has been found efficacy and safe in infants and children but it may induce adverse-effects and fentanyl causes different effects in infants and children. Following intravenous administration of fentanyl to infants and children, the fentanyl elimination half-life ranges from 208 to 1,266 min and the distribution volume ranges from 1.92 to 15.2 L/kg. Such variability is due to the wide variation of subject’s demographic characteristics. Fentanyl interacts with drugs, the treatment and trials with fentanyl have been studied in infants and children. Fentanyl freely crosses the human placenta and poorly migrates into the breast-milk. The aim of this study is to review fentanyl dosing, efficacy, safety, effects, adverse-effects, metabolism, pharmacokinetics, drug interaction, treatment, and trials in infants and children, and fentanyl placental transfer and migration into the breast-milk.

Sustaining the Use of Evidence-Based Tier 1 Literacy Practices That Benefit Students With Disabilities

The adoption and sustainability of evidence-based Tier 1 literacy practices in secondary content-area classes is important to improve the reading success among students with learning disabilities. We conducted an exploratory multiple-case study investigating teachers’ adoption and sustained use of evidence-based Tier 1 literacy practices that benefit students with learning disabilities. The study was conducted within the context of an adolescent literacy model demonstration project funded by the Office of Special Education Programs (i.e., Promoting Adolescents’ Comprehension of Text [PACT] Plus). Interviews were conducted with two administrators and seven teachers who sustained implementation of the PACT practices beyond 1 year of researcher support. Analyses revealed practice and school-level factors that influenced teachers’ sustained use of the practices. We used findings from this study to propose a model of sustainability of Tier 1 evidence-based literacy practices used to improve outcomes for students with learning disabilities. Limitations and implications for future research are provided.

Rapidly Self-Sterilizing PPE Capable of Destroying 100% of Microbes in 30-60 Seconds

The continued proliferation of superbugs in hospitals and the coronavirus disease 2019 (COVID-19) has created an acute worldwide demand for sustained broadband pathogen suppression in households, hospitals, and public spaces. In response, we have created a highly active, self-sterilizing copper configuration capable of inactivating a wide range of bacteria and viruses in 30-60 seconds. The highly active material destroys pathogens faster than any conventional copper configuration and acts as quickly as alcohol wipes and hand sanitizers. Unlike the latter, our copper material does not release volatile compounds or leave harmful chemical residues and maintains its antimicrobial efficacy over sustained use; it is shelf stable for years. We have performed rigorous testing in accordance with guidelines from U.S. regulatory agencies and believe that the material could offer broad spectrum, non-selective defense against most microbes via integration into masks, protective equipment, and various forms of surface coatings.

Market viability: a neglected concept in implementation science

This debate paper asserts that implementation science needs to incorporate a key concept from entrepreneurship—market demand—and demonstrates how assessing an innovation’s potential market viability might advance the pace and success of innovation adoption and sustainment. We describe key concepts, language distinctions, and questions that entrepreneurs pose to implementation scientists—many of which implementation scientists appear ill-equipped to answer. The paper concludes with recommendations about how concepts from entrepreneurship, notably market viability assessment, can enhance the translation of research discoveries into real-world adoption, sustained use, and population health benefits. The paper further proposes activities that can advance implementation science’s capacity to draw from the field of entrepreneurship, along with the data foundations required to assess and cultivate market demand.

The midwife of truth: The nature of irony and a rationale for its prevalence in the Gospel of John

<p>The Gospel of John is renowned for its pervasive use of irony. While this phenomenon is widely recognized by scholars, there have been only a few attempts to explain the “how” of Johannine irony and no meaningful attempt to explain its “why.” The last major treatment of the topic was by Paul Duke in his 1985 work, Irony in the Fourth Gospel, which provides an account of how Johannine irony works through an analysis of local and extended ironies. Other examinations, such as Gail O’Day’s Revelation in the Fourth Gospel in 1986, explore irony as a corollary of some other thematic concern. The reticence of scholars to delve deeper into the nature of Johannine irony is understandable given that as Duke puts it, irony laughs at all pretensions, especially the pretension of claiming to have grasped irony. This study undertakes the demanding but necessary task of describing irony to a level that allows meaningful engagement with ironic texts, while accepting that it remains ultimately indefinable. Particular attention is paid to historical shifts of understanding of the nature of irony and the implications this has for appreciating irony at a conceptual level. From a survey of the Johannine scholarship, a comprehensive but non-exhaustive overview of the Fourth Gospel’s use of irony is derived. No previous work has attempted to approach the subject in this way. The main advantage of doing so is that it allows for the identification of broad patterns of irony and the way it functions in the narrative. This in turn provides a framework for proceeding to an examination of particular texts and the identification of a possible rationale. The present study assesses several hypotheses to explain why the author of the Fourth Gospel makes such sustained use of irony. The preferred hypothesis is that it is intrinsically linked to a predominant Johannine theme of alētheia (truth). Drawing on the conceptual link between irony and truth, it argues that the truth theme is a deliberate literary strategy employed by the author to entice the reader to seek certain propositional truths within the narrative. This ultimately serves the author’s desire to evoke revelation and response in line with the Gospel’s purpose statement in 20:31. The argument that irony serves the Johannine truth theme is tested with particular reference to the Prologue (1:1-18) and the Passion Narrative (chapters 18-19). The study establishes that irony serves as the link between appearance and reality in the narrative. Its subtle and engaging qualities make irony the most suitable vehicle to testify to the Gospel’s propositional statements in a manner that fulfils the author’s stated Christological (a revelation of Jesus’ true identity) and soteriological (a response that leads to salvation) purposes.</p>

The midwife of truth: The nature of irony and a rationale for its prevalence in the Gospel of John

<p>The Gospel of John is renowned for its pervasive use of irony. While this phenomenon is widely recognized by scholars, there have been only a few attempts to explain the “how” of Johannine irony and no meaningful attempt to explain its “why.” The last major treatment of the topic was by Paul Duke in his 1985 work, Irony in the Fourth Gospel, which provides an account of how Johannine irony works through an analysis of local and extended ironies. Other examinations, such as Gail O’Day’s Revelation in the Fourth Gospel in 1986, explore irony as a corollary of some other thematic concern. The reticence of scholars to delve deeper into the nature of Johannine irony is understandable given that as Duke puts it, irony laughs at all pretensions, especially the pretension of claiming to have grasped irony. This study undertakes the demanding but necessary task of describing irony to a level that allows meaningful engagement with ironic texts, while accepting that it remains ultimately indefinable. Particular attention is paid to historical shifts of understanding of the nature of irony and the implications this has for appreciating irony at a conceptual level. From a survey of the Johannine scholarship, a comprehensive but non-exhaustive overview of the Fourth Gospel’s use of irony is derived. No previous work has attempted to approach the subject in this way. The main advantage of doing so is that it allows for the identification of broad patterns of irony and the way it functions in the narrative. This in turn provides a framework for proceeding to an examination of particular texts and the identification of a possible rationale. The present study assesses several hypotheses to explain why the author of the Fourth Gospel makes such sustained use of irony. The preferred hypothesis is that it is intrinsically linked to a predominant Johannine theme of alētheia (truth). Drawing on the conceptual link between irony and truth, it argues that the truth theme is a deliberate literary strategy employed by the author to entice the reader to seek certain propositional truths within the narrative. This ultimately serves the author’s desire to evoke revelation and response in line with the Gospel’s purpose statement in 20:31. The argument that irony serves the Johannine truth theme is tested with particular reference to the Prologue (1:1-18) and the Passion Narrative (chapters 18-19). The study establishes that irony serves as the link between appearance and reality in the narrative. Its subtle and engaging qualities make irony the most suitable vehicle to testify to the Gospel’s propositional statements in a manner that fulfils the author’s stated Christological (a revelation of Jesus’ true identity) and soteriological (a response that leads to salvation) purposes.</p>

The Contribution of Natural Design Elements to the Sustained Use of Public Space in a City Centre

<p>An increasing similarity in urban designs negatively impacts on urban space through a loss of meaning. Although the importance of meaning is stressed in the literature, this aspect of urban space has been neglected in the recent past at a time when sustainable development is also needed. A review of literature reveals that natural elements within physical settings have meaning for people and that the meanings are socially constructed by the users of the spaces. The contribution of meaning, activity, and physical elements in urban space is described in the Theory of Place. Investigating the affordance of these three components in the sustained use of small urban spaces in a city centre, where public space is at a premium and compatibility of design elements a pre‐requisite, forms the focus of this study. This research aims to bridge the gap between theory and practice by using the Theory of Place to assess natural design elements in small urban spaces. An investigation of theory, design characteristics and activity was conducted in four small urban spaces in the city centre of Wellington, New Zealand. The investigation used structured surveys with a facet approach, and photographic observation and GIS mapping of behaviour to answer the research question: Is it possible that natural design elements in public spaces influence the sustained use of a place? In addition, if observations of sustained use are related to natural design elements, is there a theoretical basis for this assertion and can it be examined through research? To answer these questions Study One examines the linkages between physical setting, social activity and meaning by investigating the behavioural and cognitive‐affective affordance of natural elements. With the results indicating a preference for natural over artificial design elements, Study Two investigated more closely how natural and artificial elements combine in design and which physical elements are likely to have strong links with other components of place. Study Three tests the validity of the theoretical findings of the initial studies by mapping user’s behaviour in small urban spaces. The convergence of the theoretical and observational research results emphasises the advantages of using both approaches in an investigation of place. Investigation of the link between meaning and activity through observation is an inferential interpretation which gives rise to the need to use complementary theoretical research with reliable predictive power. While designers should consider theory in design they should also be aware of the practical importance of creating meaningful combinations of design elements that meet the diverse needs and changing users and uses over time.</p>

The Contribution of Natural Design Elements to the Sustained Use of Public Space in a City Centre

<p>An increasing similarity in urban designs negatively impacts on urban space through a loss of meaning. Although the importance of meaning is stressed in the literature, this aspect of urban space has been neglected in the recent past at a time when sustainable development is also needed. A review of literature reveals that natural elements within physical settings have meaning for people and that the meanings are socially constructed by the users of the spaces. The contribution of meaning, activity, and physical elements in urban space is described in the Theory of Place. Investigating the affordance of these three components in the sustained use of small urban spaces in a city centre, where public space is at a premium and compatibility of design elements a pre‐requisite, forms the focus of this study. This research aims to bridge the gap between theory and practice by using the Theory of Place to assess natural design elements in small urban spaces. An investigation of theory, design characteristics and activity was conducted in four small urban spaces in the city centre of Wellington, New Zealand. The investigation used structured surveys with a facet approach, and photographic observation and GIS mapping of behaviour to answer the research question: Is it possible that natural design elements in public spaces influence the sustained use of a place? In addition, if observations of sustained use are related to natural design elements, is there a theoretical basis for this assertion and can it be examined through research? To answer these questions Study One examines the linkages between physical setting, social activity and meaning by investigating the behavioural and cognitive‐affective affordance of natural elements. With the results indicating a preference for natural over artificial design elements, Study Two investigated more closely how natural and artificial elements combine in design and which physical elements are likely to have strong links with other components of place. Study Three tests the validity of the theoretical findings of the initial studies by mapping user’s behaviour in small urban spaces. The convergence of the theoretical and observational research results emphasises the advantages of using both approaches in an investigation of place. Investigation of the link between meaning and activity through observation is an inferential interpretation which gives rise to the need to use complementary theoretical research with reliable predictive power. While designers should consider theory in design they should also be aware of the practical importance of creating meaningful combinations of design elements that meet the diverse needs and changing users and uses over time.</p>

Association between behavioral phenotypes and sustained use of smartphones and wearable devices to remotely monitor physical activity

Smartphones and wearable devices can be used to remotely monitor health behaviors, but little is known about how individual characteristics influence sustained use of these devices. Leveraging data on baseline activity levels and demographic, behavioral, and psychosocial traits, we used latent class analysis to identify behavioral phenotypes among participants randomized to track physical activity using a smartphone or wearable device for 6 months following hospital discharge. Four phenotypes were identified: (1) more agreeable and conscientious; (2) more active, social, and motivated; (3) more risk-taking and less supported; and (4) less active, social, and risk-taking. We found that duration and consistency of device use differed by phenotype for wearables, but not smartphones. Additionally, “at-risk” phenotypes 3 and 4 were more likely to discontinue use of a wearable device than a smartphone, while activity monitoring in phenotypes 1 and 2 did not differ by device type. These findings could help to better target remote-monitoring interventions for hospitalized patients.

Sustaining allied health telehealth services beyond the rapid response to COVID-19: Learning from patient and staff experiences at a large quaternary hospital

The patient, clinician and administration staff perspectives of telehealth (specifically videoconferencing) services provided by Allied Health Professions (AHP) at a large quaternary hospital were explored. The purpose was to understand stakeholders’ perceptions of the service during initial COVID-19 restrictions and examine factors that influenced the implementation and sustained use of telehealth. A sequential mixed-methods approach was undertaken. Stage 1 involved surveys completed by patients (n = 109) and clinicians (n = 66) who received and provided care via telehealth, respectively, across six AHP departments. Stage 2 involved focus groups with clinicians (n = 24) and administrative staff (n = 13) to further examine implementation and sustainability factors. All participant groups confirmed that telehealth was a valid service model and valued the benefits it afforded, particularly during COVID-19 restrictions. Both patients and clinicians reported that not all AHP services could be delivered via telehealth and preferred a blended model of telehealth and in-person care. Increased administrative staff assistance was needed to support growing telehealth demand. Main factors to address are the need to expand AHP telehealth models and workforce/patient training, improve workflow processes and enhance technical support. Despite rapid implementation, telehealth experiences were overall positive. Study findings are being used to generate solutions to enhance and sustain AHP telehealth services.