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1. Book reviews

Author

Barbara Abbott, Annette Herskovits, Philip L. Peterson, Alfred R. Mele, David J. Cole, Daniel Crevier, Francis Jeffry Pelletier, Istvan S. N. Berkeley, Brendan J. Kitts, Mike Brown, and George Paliouras

Subjects
Philosophy, Artificial Intelligence
Published
1996
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2. Abstracts

Author

Saiah Michèle, Borgeat Alain, Wilder-Smith Oliver, Orlando R. Hung, Charles E. Hope, Geoffrey Laney, Sara C. Whynot, Thomas J. Coonan, David S. Malloy, S. Patterson, A. Gelb, P. Manninen, D. Strum, B. Glosten, M. J. Spellman, E. I. Eger, R. A. Craen, A. W. Gelb, J. M. Murkin, K. Y. Chong, D. H. Penning, H. El-Behairy, J. F. Brien, J. W. Coh, R. Arellano, J. Correa, L. Fedorko, Z. Liu, J. F. Boylan, A. N. Sandler, H. Nierenberg, P. A. Sheiner, P. D. Greig, G. M. O’Leary, S. J. Teasdale, M. F. X. Glynn, B. A. Orser, L. -Y. Wang, J. F. MacDonald, C. W. Loomis, K. D. Arunachalam, D. Vyas, B. Milne, Daniel Gagnon, Josée Lavoie, Jean-Yves Dupuis, D. R. Miller, R. J. Martineau, D. Greenway, L. Olivaris, K. Hull, R. N. M. Tierney, J. E. Wynands, R. Martineau, B. St-Jean, J. Kitts, D. Miller, P. Lindsay, M. Curran, G. C. Allen, M. L. Crossan, Richard Wise, François Donati, David R. Bevan, J. F. Hardy, J. Desroches, J. Perrault, M. Carrier, D. Robitaille, D. M. Ansley, J. P. O’Connor, J. Dolman, G. E. Townsend, D. Ricci, D. J. Liepert, P. M. Browne, T. Hertz, M. Rooney, R. W. Yip, W. Code, A. A. Phillips, R. F. McLean, J. H. Devitt, E. M. Harrington, R. J. Byrick, P. Y. Wong, D. Wigglesworth, J. C. Kay, L. A. Sinclair, J. P. Koch, K. A. Deemar, G. K. Christakis, S. Belo, P. Angle, D. Cheng, J. Boylan, A. Sandler, C. Feindel, F. Carmichael, P. Boylen, L. G. R. DeLima, H. J. Nathan, M. S. Hynes, M. E. Bourke, G. N. Russell, C. Seyone, F. Chung, Daniel Chartrand, Lucie Roux, S. L. Dain, B. D. Smith, A. C. Webster, D. F. Wigglesworth, D. K. Rose, G. Caskennette, C. Mechetuk, D. John Doyle, Wilfred DeMajo, Frank van den Bosch, Mark Lee, K. M. McClenaghan, C. D. Mazer, R. Preston, E. T. Crosby, D. Kotarba, H. Dudas, R. D. Elliott, J. Enns, P. H. Manninen, J. K. Farrar, David L. Huzyka, L. Philip Lin, Susan Fossey, Brendan T. Finucane, M. Stockwell, S. Lozanoff, S. Lang, J. Hyssen, D. C. Campbell, M. J. Douglas, T. J. G. Pavy, M. L. Flanagan, G. H. McMorland, Colin Bands, Ch. B. Ffaracs, Catherine Lipsett, David Drover, Mark Stafford-Smith, Sarah Stevens, Kate Shields, Michael J. MacSween, J. D. McAllister, P. K. Morley-Forster, A. K. White, M. D. Taylor, H. M. Vandenberghe, D. Knoppert, H. Reimer, P. C. Duke, C. H. Kehler, M. W. Kepron, V. A. Taraska, J. Carstoniu, P. Norman, J. Katz, Medhat Hannallah, C. M. Cooney, J. B. Lyons, A. Hennigan, W. P. Blunnie, D. C. Moriarty, W. B. Dobkowski, F. S. Prato, N. A. Shannon, D. J. Drost, B. Arya, J. M. Wills, D. Bond, P. Morley-Forester, Mullen JB, I. Spahr-Schopfer, J. Lerman, E. Cutz, M. Dolovich, S. Kowalski, B. Ong, D. Bell, T. Ostryzniuk, C. Serrette, T. Wasylak, S. Coke, Takako Tsuda, Takashi Nakagawa, Norifumi Mabuchi, Hiroshi Ando, Osamu Nishida, Takafumi Azami, Hirotada Katsuya, Yukio Goto, N. Searle, M. Roy, null R. R. T., Charles E. Smith, Alfred C. Pinchak, Joan F. Hagen, Donald Hancock, Andrei V. Krassioukov, Lynne C. Weaver, I. R. Sutton, W. A. C. Mutch, J. M. Teskey, I. R. Thomson, M. Rosenbloom, D. Thiessen, S. Teasdale, H. Corbin, M. R. Graham, S. A. Lang, P. Chang, M. Gerard, J. E. Tetzlaff, M. Walsh, H. Yoon, Brian Warriner, Peter Fancourt-Smith, Jim McEwen, Judy Crane, N. H. Badner, R. Bhandari, W. E. Komar, S. Ganapathy, C. B. Warriner, J. P. McCormack, M. Levine, N. Glick, V. W. S. Chan, M. McQuestion, M. Gomez, C. Cruise, D. Evana, D. Shumka, R. J. Smyth, M. Graham, David Halpenny, Gerald V. Goresky, J. Eldon Zaretski, B. Kavanagh, S. Roger, A. Davies, M. Friedlander, M. M. Cohen, P. G. Duncan, W. D. B. Pope, D. Biehl, R. Merchant, W. A. Tweed, Michael J. Tessler, Mark Angle, Simcha Kleiman, B. P. Kavanagh, G. J. Doak, G. Li, R. I. Hall, J. A. Sulliyan, I. Yee, S. Halpern, R. Pittini, C. Huh, G. L. Bryson, R. Gverzdys, C. Perreault, L. Ferland, F. Gobeil, D. Girard, R. Smyth, B. Asokumar, M. Glynn, Sandra Silveira, Jeff Clark, Paul Milgram, W. M. Splinter, H. B. MacNeill, E. A. Ménard, E. J. Rhine, D. J. Roberts, G. M. Gould, G. G. Johnson, Daniel Quance, Saul Wiesel, Jane Easdown, N. Tien Truong, Normand Miller, Nathan Sheiner, L. Welborn, J. Norden, R. Hannallah, L. Broadman, N. Seiden, M. Iwai, R. Iwai, H. Horigome, M. Yamashita, Catherine E. Wood, Kim Klassen, S. Kleinman, S. Yentis, N. Sikich, T. A. Yemen, B. Mascik, W. Nelson, H. Ghantous, J. Gandolfi, Gordon Wood, Mohamed Ali, Kevin Inman, J. M. Karski, J. Carroll, D. Brooks, P. A. Oakley, P. M. Webster, J. Karski, T. Yao, J. Ivanov, P. Young, S. Carson, R. D. Weisel, Richard M. Cooper, David T. Wong, Douglas P. Wagner, William A. Knaus, Charul A. Munshi, John P. Kampine, I. D. Soutter, A. Mathieu, A. Gafni, A. Dauphin, L. Torsher, M. Tierney, H. S. Hopkins, G. J. Baylon, Elizabeth A. Peter, C. P. Bellhouse, Caroline Dore, T. W. Rachwal, D. T. Lanigan, Raymond Yip, J. B. Derdemezi, B. A. Britt, D. E. Withington, F. Reynolds, A. Patrick, W. Man, N. R. Searle, H. Ste-Marie, Mark A. Kostash, Richard Johnston, R. J. Bailey, M. D. Sharpe, R. P. Woda, M. Haug, P. Slugg, J. Lockrem, G. Barnett, B. A. Finegan, M. Robertson, D. Taylor, G. Frost, A. Koshal, Grant E. Rodney, Clayton C. Reichert, Desmond N. O’Regan, Derek Blackstock, David J. Steward, Richard Wenstone, Ellen Harrington, A. Wong, B. Braude, D. Fear, B. Bissonnette, Craig W. Reid, Kathryn A. Hull, S. Yogendran, G. McGuire, V. Chan, E. Hartley, K. Van Kessel, R. Weisel, N. Takla, N. A. Tremblay, F. E. Ralley, J. G. Ramsay, G. R. Robbins, F. C. Salevsky, S. Gandhi, N. Nimphius, Bernard Dionne, Christian Jodoin, Michel Lorange, Alain Lapointe, Geoffrey Hawboldt, G. A. Volgyesi, Guy Tousignant, R. Barnett, and B. Gallant

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1992
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3. Finite Element Modeling and Effect of Electrical/Mechanical Parameters on Electromechanical Impedance Damage Detection

Author

Andrei Zagrai and Daniel J. Kitts

Subjects
Engineering, business.industry, Piezoelectric sensor, EMI, Acoustics, Multiphysics, Structural engineering, Dissipation, business, Piezoelectricity, Electrical impedance, Finite element method, Structural element
Abstract

Electromechanical Impedance (EMI) is a popular SHM technique, which has found applications in many fields of engineering: mechanical, aerospace, civil and others. Active elements of the technique are piezoelectric wafer active sensors bonded or embedded into a structural element. EMI detection of structural damage is achieved by comparing high frequency structural dynamic signatures reflected in the electromechanical impedance measured at the sensor terminals. Over a past decade, substantial efforts have been devoted to analytical and numerical modeling of various aspects of EMI method. The majority of prior studies focused on fundamental understanding of the sensor transduction mechanism and sensor-structure interaction. Although basic principles of the EMI method are now well understood, modeling of practical structural diagnostic scenarios remains challenging. This contribution expands current modeling efforts in the EMI SHM by considering issues related to energy dissipation in piezoelectric sensor and host structure, as well as its effect on detectability of structural damage. Piezoelectric element and a host structure were modeled using Comsol® Multiphysics finite element package. The finite element implementation allowed for considering contributions of active material, adhesive bond and structural damage. These contributions were studied parametrically for various model settings including mechanical and electrical losses. The study shows that sensor position may directly control damage manifestation in EMI signature; effect of adhesive bond thickness is comparable in magnitude to the effect of bond stiffness; influence of piezoelectric mechanical losses on the impedance signature is different for damaged and undamaged cases.Copyright © 2009 by ASME

Published
2009
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5. A Prospective, Randomized, Controlled Study of Intraoperative Efficacy and Postoperative Myalgia of Mivacurium with or without Reversal Agents in Comparisons to Succinylcholine in Ambulatory Surgical Patients

Author

J. Kitts, Davy Cheng, C. Cruise, S. Paramanathar, Alan N. Sandler, Frances Chung, B. Asokumar, and R. Arellano

Subjects
myalgia, medicine.medical_specialty, business.industry, law.invention, Surgery, Anesthesiology and Pain Medicine, Randomized controlled trial, law, Anesthesia, Ambulatory, Medicine, medicine.symptom, business, Surgical patients
Published
1994
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6. Erratum

Author

Saiah Michèle, Borgeat Alain, Wilder-Smith Oliver, Orlando R. Hung, Charles E. Hope, Geoffrey Laney, Sara C. Whynot, Thomas J. Coonan, David S. Malloy, S. Patterson, A. Gelb, P. Manninen, D. Strum, B. Glosten, M. J. Spellman, E. I. Eger, R. A. Craen, A. W. Gelb, J. M. Murkin, K. Y. Chong, D. H. Penning, H. El-Behairy, J. F. Brien, J. W. Coh, R. Arellano, J. Correa, L. Fedorko, Z. Liu, J. F. Boylan, A. N. Sandler, H. Nierenberg, P. A. Sheiner, P. D. Greig, G. M. O’Leary, S. J. Teasdale, M. F. X. Glynn, B. A. Orser, L. -Y. Wang, J. F. MacDonald, C. W. Loomis, K. D. Arunachalam, D. Vyas, B. Milne, Daniel Gagnon, Josée Lavoie, Jean-Yves Dupuis, D. R. Miller, R. J. Martineau, D. Greenway, L. Olivaris, K. Hull, R. N. M. Tierney, J. E. Wynands, R. Martineau, B. St-Jean, J. Kitts, D. Miller, P. Lindsay, M. Curran, G. C. Allen, M. L. Crossan, Richard Wise, François Donati, David R. Bevan, J. F. Hardy, J. Desroches, J. Perrault, M. Carrier, D. Robitaille, D. M. Ansley, J. P. O’Connor, J. Dolman, G. E. Townsend, D. Ricci, D. J. Liepert, P. M. Browne, T. Hertz, M. Rooney, R. W. Yip, W. Code, A. A. Phillips, R. F. McLean, J. H. Devitt, E. M. Harrington, R. J. Byrick, P. Y. Wong, D. Wigglesworth, J. C. Kay, L. A. Sinclair, J. P. Koch, K. A. Deemar, G. K. Christakis, S. Belo, P. Angle, D. Cheng, J. Boylan, A. Sandler, C. Feindel, F. Carmichael, P. Boylen, L. G. R. DeLima, H. J. Nathan, M. S. Hynes, M. E. Bourke, G. N. Russell, C. Seyone, F. Chung, Daniel Chartrand, Lucie Roux, S. L. Dain, B. D. Smith, A. C. Webster, D. F. Wigglesworth, D. K. Rose, G. Caskennette, C. Mechetuk, D. John Doyle, Wilfred DeMajo, Frank Bosch, Mark Lee, K. M. McClenaghan, C. D. Mazer, R. Preston, E. T. Crosby, D. Kotarba, H. Dudas, R. D. Elliott, J. Enns, P. H. Manninen, J. K. Farrar, David L. Huzyka, L. Philip Lin, Susan Fossey, Brendan T. Finucane, M. Stockwell, S. Lozanoff, S. Lang, J. Hyssen, D. C. Campbell, M. J. Douglas, T. J. G. Pavy, M. L. Flanagan, G. H. McMorland, Colin Bands, Ch. B. Ffaracs, Catherine Lipsett, David Drover, Mark Stafford-Smith, Sarah Stevens, Kate Shields, Michael J. MacSween, J. D. McAllister, P. K. Morley-Forster, A. K. White, M. D. Taylor, H. M. Vandenberghe, D. Knoppert, H. Reimer, P. C. Duke, C. H. Kehler, M. W. Kepron, V. A. Taraska, J. Carstoniu, P. Norman, J. Katz, Medhat Hannallah, C. M. Cooney, J. B. Lyons, A. Hennigan, W. P. Blunnie, D. C. Moriarty, W. B. Dobkowski, F. S. Prato, N. A. Shannon, D. J. Drost, B. Arya, J. M. Wills, D. Bond, P. Morley-Forester, Mullen JB, I. Spahr-Schopfer, J. Lerman, E. Cutz, M. Dolovich, S. Kowalski, B. Ong, D. Bell, T. Ostryzniuk, C. Serrette, T. Wasylak, S. Coke, Takako Tsuda, Takashi Nakagawa, Norifumi Mabuchi, Hiroshi Ando, Osamu Nishida, Takafumi Azami, Hirotada Katsuya, Yukio Goto, N. Searle, M. Roy, null R. R. T., Charles E. Smith, Alfred C. Pinchak, Joan F. Hagen, Donald Hancock, Andrei V. Krassioukov, Lynne C. Weaver, I. R. Sutton, W. A. C. Mutch, J. M. Teskey, I. R. Thomson, M. Rosenbloom, D. Thiessen, S. Teasdale, H. Corbin, M. R. Graham, S. A. Lang, P. Chang, M. Gerard, J. E. Tetzlaff, M. Walsh, H. Yoon, Brian Warriner, Peter Fancourt-Smith, Jim McEwen, Judy Crane, N. H. Badner, R. Bhandari, W. E. Komar, S. Ganapathy, C. B. Warriner, J. P. McCormack, M. Levine, N. Glick, V. W. S. Chan, M. McQuestion, M. Gomez, C. Cruise, D. Evana, D. Shumka, R. J. Smyth, M. Graham, David Halpenny, Gerald V. Goresky, J. Eldon Zaretski, B. Kavanagh, S. Roger, A. Davies, M. Friedlander, M. M. Cohen, P. G. Duncan, W. D. B. Pope, D. Biehl, R. Merchant, W. A. Tweed, Michael J. Tessler, Mark Angle, Simcha Kleiman, B. P. Kavanagh, G. J. Doak, G. Li, R. I. Hall, J. A. Sulliyan, I. Yee, S. Halpern, R. Pittini, C. Huh, G. L. Bryson, R. Gverzdys, C. Perreault, L. Ferland, F. Gobeil, D. Girard, R. Smyth, B. Asokumar, M. Glynn, Sandra Silveira, Jeff Clark, Paul Milgram, W. M. Splinter, H. B. MacNeill, E. A. Ménard, E. J. Rhine, D. J. Roberts, G. M. Gould, G. G. Johnson, Daniel Quance, Saul Wiesel, Jane Easdown, N. Tien Truong, Normand Miller, Nathan Sheiner, L. Welborn, J. Norden, R. Hannallah, L. Broadman, N. Seiden, M. Iwai, R. Iwai, H. Horigome, M. Yamashita, Catherine E. Wood, Kim Klassen, S. Kleinman, S. Yentis, N. Sikich, T. A. Yemen, B. Mascik, W. Nelson, H. Ghantous, J. Gandolfi, Gordon Wood, Mohamed Ali, Kevin Inman, J. M. Karski, J. Carroll, D. Brooks, P. A. Oakley, P. M. Webster, J. Karski, T. Yao, J. Ivanov, P. Young, S. Carson, R. D. Weisel, Richard M. Cooper, David T. Wong, Douglas P. Wagner, William A. Knaus, Charul A. Munshi, John P. Kampine, I. D. Soutter, A. Mathieu, A. Gafni, A. Dauphin, L. Torsher, M. Tierney, H. S. Hopkins, G. J. Baylon, Elizabeth A. Peter, C. P. Bellhouse, Caroline Dore, T. W. Rachwal, D. T. Lanigan, Raymond Yip, J. B. Derdemezi, B. A. Britt, D. E. Withington, F. Reynolds, A. Patrick, W. Man, N. R. Searle, H. Ste-Marie, Mark A. Kostash, Richard Johnston, R. J. Bailey, M. D. Sharpe, R. P. Woda, M. Haug, P. Slugg, J. Lockrem, G. Barnett, B. A. Finegan, M. Robertson, D. Taylor, G. Frost, A. Koshal, Grant E. Rodney, Clayton C. Reichert, Desmond N. O’Regan, Derek Blackstock, David J. Steward, Richard Wenstone, Ellen Harrington, A. Wong, B. Braude, D. Fear, B. Bissonnette, Craig W. Reid, Kathryn A. Hull, S. Yogendran, G. McGuire, V. Chan, E. Hartley, K. Kessel, R. Weisel, N. Takla, N. A. Tremblay, F. E. Ralley, J. G. Ramsay, G. R. Robbins, F. C. Salevsky, S. Gandhi, N. Nimphius, Bernard Dionne, Christian Jodoin, Michel Lorange, Alain Lapointe, Geoffrey Hawboldt, G. A. Volgyesi, Guy Tousignant, R. Barnett, and B. Gallant

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1992
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7. Biological Species as Natural Kinds

Author

David J. Kitts and David B. Kitts

Subjects
Scientific law, Philosophy, History, Natural kind, History and Philosophy of Science, Biological species, Ecology, Reproductive isolation, Biology, Evolutionary theory, Natural (archaeology)
Abstract

The fact that the names of biological species refer independently of identifying descriptions does not support the view of Ghiselin and Hull that species are individuals. Species may be regarded as natural kinds whose members share an essence which distinguishes them from the members of other species and accounts for the fact that they are reproductively isolated from the members of other species. Because evolutionary theory requires that species be spatiotemporally localized their names cannot occur in scientific laws. If natural kind status is denied to species on this ground, it must also be denied to most classes of concrete entities which are now accorded such status.

Published
1979
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10. Policy and Economic Considerations for Frailty Screening in the Canadian Healthcare System.

Author

Grimes K, Kitts J, Tholl B, Samuelson-Kiraly C, and Mitchell JI

Subjects
Aged, Canada, Frail Elderly, Humans, Delivery of Health Care economics, Frailty diagnosis, Health Policy, Mass Screening economics
Abstract

Canada faces significant policy and economic challenges related to healthcare for frail older adults. Annual per capita healthcare costs for people over age 65 are five times those for people under 65. Flat economic growth and an aging workforce decrease tax revenue, which funds 70% of health spending. Governments are shifting policy to enhance person-centered care and shifting spending from hospitals to primary and community care. Recognizing that frailty and evidence-based frailty screening can contribute directly to reform initiatives, what are the policy and economic considerations, both nationally and internationally, around frailty screening that will benefit patients, families and/or the wider health system? Based on key informant interviews, we present recommendations for approaching policy and economic challenges in frailty through the following healthcare policy instruments: financing, funding, legislation, regulation, technology, interdisciplinary care, person-centered service and health promotion., Competing Interests: None

Published
2018
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11. Clinical and dermoscopic features of combined cutaneous squamous cell carcinoma (SCC)/neuroendocrine [Merkel cell] carcinoma (MCC).

Author

Suárez AL, Louis P, Kitts J, Busam K, Myskowski PL, Wong RJ, Chen CS, Spencer P, Lacouture M, and Pulitzer MP

Subjects
Age Factors, Aged, Aged, 80 and over, Biopsy, Needle, Carcinoma, Merkel Cell diagnosis, Carcinoma, Merkel Cell mortality, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell mortality, Databases, Factual, Female, Humans, Immunohistochemistry, Male, Middle Aged, Neoplasm Invasiveness pathology, Neoplasm Staging, Neoplasms, Multiple Primary diagnosis, Neoplasms, Multiple Primary mortality, Prognosis, Retrospective Studies, Risk Assessment, Sex Factors, Skin Neoplasms diagnosis, Skin Neoplasms mortality, Survival Rate, Treatment Outcome, Carcinoma, Merkel Cell pathology, Carcinoma, Squamous Cell pathology, Dermoscopy methods, Neoplasms, Multiple Primary pathology, Skin Neoplasms pathology
Abstract

Background: Merkel cell carcinoma (MCC) is a neuroendocrine carcinoma, associated with Merkel cell polyomavirus. MCC admixed with squamous cell carcinoma (SCC) is unassociated with polyomavirus, and is genetically distinct., Objective: We sought to distinguish clinically and dermoscopically between MCC and SCC/MCC., Methods: We compared patient data for SCC/MCC (n = 26) and MCC (n = 20), and reviewed clinical and dermoscopic images (n = 9) of SCC/MCC., Results: Patients with SCC/MCC were older (median 76.5 vs 69 years) and more often male (77% vs 60%), and had more nonmelanoma skin cancer (85% vs 25%), malignant extracutaneous tumors (25% vs 5%), lymphoproliferative disorders (23% vs 10%), and immunodeficient/proinflammatory states (77% vs 35%). In all, 58% of SCC/MCC versus 10% of MCC were clinically diagnosed nonmelanoma skin cancer. Patients with SCC/MCC had more metastases (77% vs 40%), more treatment failures (53% vs 45%), shorter survival (41 vs 54 months), and more death from disease (50% vs 40%). SCC/MCC demonstrated marked scale (7/9), and telangiectasia (1/9). Dermoscopically, small dotted and short linear irregular peripheral vessels and central milky-red areas with large-diameter arborizing vessels were seen., Limitations: The rarity of SCC/MCC limits available data., Conclusions: SCC/MCC is aggressive, arising within elderly patients' chronically ultraviolet-exposed skin, often in the setting of immunosuppression or inflammation. Dermoscopically, polymorphous vessels in lesions suspicious for nonmelanoma skin cancer are suggestive., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Published
2015
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12. Psychological health and safety in Canadian healthcare settings.

Author

Kitts J

Subjects
Burnout, Professional prevention & control, Canada, Health Personnel psychology, Humans, Workplace psychology, Workplace standards, Health Facilities standards, Occupational Health standards
Abstract

Psychological health and safety are growing priorities in Canadian workplaces, including Canadian healthcare settings. The workplace has a key role to play in promoting mental health. The Canadian Healthcare Association recently adopted a position statement strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard, outlined in Psychological Health and Safety in the Workplace., (Copyright © 2013 Longwoods Publishing.)

Published
2013
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15. United Nations Special Session on Children: children's rights under attack.

Author

Kitts J and McDonald K

Subjects
Acquired Immunodeficiency Syndrome prevention & control, Adolescent, Adolescent Behavior, Child, Female, Humans, International Cooperation, Male, Policy Making, Pregnancy, Religion and Medicine, Sexuality, Adolescent Health Services, Child Welfare, Global Health, Health Policy, Patient Advocacy, Pregnancy in Adolescence prevention & control, Sexually Transmitted Diseases prevention & control
Published
2002

16. Pharmacodynamics of doxacurium during cardiac surgery with hypothermic cardiopulmonary bypass.

Author

McDonagh P, Dupuis JY, Curran M, Kitts J, and Wynands JE

Subjects
Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Time Factors, Cardiopulmonary Bypass, Isoquinolines pharmacology, Neuromuscular Nondepolarizing Agents pharmacology
Abstract

Purpose: To determine the characteristics of neuromuscular block produced by two and three times the 95% effective dose (ED95) of doxacurium in patients undergoing coronary artery surgery with hypothermic cardiopulmonary bypass., Methods: In a prospective non randomized study, ten patients received doxacurium 0.05 mg.kg-1 (Group 1) and ten others received 0.075 mg.kg-1 (Group 2) with midazolam and sufentanil. The mechanomyographic response of the adductor pollicis muscle after supramaximal train-of-four (TOF) stimulation of the ulnar nerve was recorded intraoperatively and postoperatively. Additional doxacurium (10% of the initial dose) was administered until sternal closure whenever the first twitch (T1) had recovered to 25% of control., Results: The onset time (time to maximal T1 depression) of doxacurium was 390 +/- 148 sec in Group 1 and 370 +/- 74 sec in Group 2 (P = 0.71). The clinical duration of neuromuscular block (time to 25% T1 recovery) was 165 +/- 90 min in Group 1 and 258 +/- 86 in Group 2 (P = 0.03). On arrival to recovery room the mean T1 was 57 +/- 23% in Group 1 and 24 +/- 21% in Group 2 (P = 0.003); the mean T4/T1 ratio was 0.25 +/- 0.15 for five patients of Group 1 with four responses to TOF stimulation and 0.10 for the only patient of Group 2 with four twitches., Conclusion: In contrast with findings in patients without cardiac disease, this study shows comparable onset times of doxacurium with doses of two and three times ED95. The clinical duration of doxacurium is 60 to 100% longer than previously reported in noncardiac surgery.

Published
1996
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17. Reversal of neuromuscular blockade in humans by neostigmine and edrophonium: a mathematical model.

Author

Verotta D, Kitts J, Rodriguez R, Coldwell J, Miller RD, and Sheiner LB

Subjects
Adult, Humans, Mathematics, Middle Aged, Edrophonium pharmacology, Models, Biological, Neostigmine pharmacology, Vecuronium Bromide antagonists & inhibitors
Abstract

Generalizations of the integrated model describing the interaction of nondepolarizing neuromuscular blocking drugs with reversible anticholinesterase drugs described in Unadkat et al. (1) are reported. The models can deal with possible incomplete reversal (irreversible block) and/or noninstantaneous anticholinesterase kinetics. Experimental data were obtained from 22 human volunteers. Different levels of steady-state vecuronium block were induced in each volunteer (in the range of 50% to 95%), and reversed by short infusions of edrophonium (10 volunteers) or neostigmine (12 volunteers). Edrophonium or neostigmine concentrations and twitch tension (measured as the force of thumb adduction) were measured. The generalized integrated models fit the data well. In the case of neostigmine we find a nondistributional delay in its action. We relate this delay to the slow decarbamylation rate of the (neostigmine-induced) carbamylated anticholinesterase observed in vitro, and are able to model such noninstantaneous anticholinesterase kinetic processes. For both edrophonium and neostigmine we detect an inverse relationship between the (induced) level of initial block and maximal percentage recovery.

Published
1991
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18. Naloxone infusion after prophylactic epidural morphine: effects on incidence of postoperative side-effects and quality of analgesia.

Author

Gowan JD, Hurtig JB, Fraser RA, Torbicki E, and Kitts J

Subjects
Aged, Blood Gas Analysis, Clinical Trials as Topic, Diazepam, Double-Blind Method, Female, Humans, Isoflurane, Male, Middle Aged, Naloxone adverse effects, Nitrous Oxide, Preanesthetic Medication, Random Allocation, Respiratory Function Tests, Analgesia, Anesthesia, Epidural adverse effects, Morphine adverse effects, Morphine antagonists & inhibitors, Naloxone therapeutic use, Postoperative Complications prevention & control
Abstract

There have been conflicting reports of the value of naloxone infusions to prevent the side-effects associated with epidural morphine. In our study, 29 patients undergoing thoracotomies for pulmonary surgery received epidural morphine (0.1 mg.kg-1) shortly after induction of anaesthesia. One hour after arrival in the Recovery Room, one of four naloxone bolus and infusion sequences was administered: saline bolus followed by saline infusion; 0.4 microgram.kg-1 naloxone bolus followed by 0.4 microgram.kg-1.hr-1 naloxone infusion; 2.0 micrograms.kg-1 naloxone bolus followed by 2.0 micrograms.kg-1.hr-1 naloxone infusion; and 4.0 micrograms.kg-1 naloxone bolus followed by 4.0 micrograms.kg-1.hr-1 naloxone infusion. Although with the number of patients studied, there were no statistically significant differences among groups, clinically, there was a trend toward decreased analgesia with all three naloxone infusion doses as determined by analgesic requirements, longest analgesic-free period and visual analogue pain scores. In addition, side-effects occurred in all groups. We conclude that prophylactic naloxone, used in this manner, is not an appropriate technique for the prevention of side-effects associated with epidural morphine used for the prevention of pain after thoracotomy.

Published
1988
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