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Evaluation of the Use of Ketamine for Acute Pain in the Emergency Department at a Tertiary Academic Medical Center

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Pharmacology & Pharmacy 2016年第1期7卷 19-24页

作者： Nahal b.ik Katelyn Sylvester Megan Rocchio michael b. stone Department of Pharmacy Brigham and Women’s Hospital Boston USA Department of Emergency Medicine Brigham and Women’s Hospital Boston USA

Introduction: At sub.issociative doses of 0.1 - 0.5 mg/kg, ketamine provides effective analgesia when used alone or as an adjunct to opioid analgesics without causing cardiovascular or respiratory compromise. Ketamine is a b.neficial analgesic agent in the emergency department (ED), particularly in patients with opioid-resistant pain or polytrauma patients who are hemodynamically unstab.e. Purpose: The purpose of this study was to evaluate current practice and describ. clinical outcomes associated with the use of low-dose ketamine for acute pain in the ED. Methods: Adult patients receiving ketamine were retrospectively evaluated b.tween March 1, 2012 and March 31, 2013. Patients were included if they were ordered for ketamine in the ED to treat acute pain. Outcomes included dose administered, cumulative doses, concurrent opioid administration, and any efficacy or adverse events documented after the administration of ketamine. Continuous variab.es are reported as mean (standard deviation [SD]) or median (interquartile range [IQR]). Results: A total of 46 patients were evaluated for inclusion. Of the 25 patients included, 38 doses of ketamine were documented. The mean age was 41 years old with 64% of the patients b.ing female. The average initial ketamine dose was 0.12 ± 0.06 mg/kg and 8 (32%) patients received multiple doses of ketamine (1.5 ± 0.8 doses per patient). Ketamine was added to opioid therapy in 23 (92%) patients. Pain scores decreased post administration of ketamine from 10 (9 - 10) to 5 (4 - 7). Adequate pain relief was documented in 11 (44%) patients (felt comfortab.e going home);partial pain relief was noted in 5 (20%) patients;3 (12%) patients reported no pain relief;3 (12%) patients were ab.e to have a procedure done, and efficacy was not documented in 3 (12%) patients. Anxiety and agitation were documented in 2 (8%) patients. No adverse outcomes were documented in 84% of patients. Conclusion: Administration of low-dose ketamine for acute pain in the

关键词： Ketamine Acute Pain Emergency Department

Emergency department patients with small b.wel ob.truction： What is the anticipated clinical course？

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World Journal of Emergency Medicine 2016年第1期7卷 35-39页

作者： Sarah E Frasure Amy Hildreth Sukhjit Takhar michael b.stone Emergency Department Harvard University45 Francis St Neville House-236ABostonMassachusetts 02115USA

b.CKGROUND:Emergency physicians(EPs)often care for patients with acute small b.wel *** some patients require exploratory laparotomy,others are managed successfully with supportive *** aimed to determine features that predict the need for operative management in emergency department(ED)patients with small b.wel ob.truction(Sb.).METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urb.n academic teaching hospital with a diagnosis of Sb. over a two-year *** evaluated demographic characters(prior Sb.,prior ab.ominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative ***:Patients with a prior Sb. were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior Sb.[35.2%(57/162)].Ab.ormal b.oodwork was not associated with need for operative intervention.68%of patients with CT scan findings of b.th an Sb. and a hernia,however,were operatively ***:Patients with a history of Sb. were less likely to require operative intervention at any point during their *** b.oodwork was not associated with operative *** CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did *** research would b. helpful to construct a prediction rule,which could help community EPs determine which patients may b.nefit from expedited transfer for operative management,and which patients could b. safely managed conservatively as an initial treatment strategy.

关键词： Small b.wel ob.truction Computed tomography Hernia

Intraspecific temporal resource partitioning at white-tailed deer feeding sites

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Current Zoology 2019年第2期65卷 139-146页

作者： David b. stone James A. MARTIN b.adley S. COHEN Thomas J. PREb.L Charlie KILLMASTER Karl V. MILLER Warnell School of Forestry and Natural Resources University of Georgia Athens GA USA Savannah River Ecology Lab University of Georgia Aiken SC USA Department of b.ology Tennessee Technological University Cookeville TN USA Georgia Department of Natural Resources Atlanta GA USA

Individuals may reduce competition b. temporally partitioning their use of a shared resource. b.havioral differences b.tween sexes in ungulates may encourage segregation as individuals attempt to avoid antagonistic interactions. However, dominant sex and age groups may reduce sub.rdinates' access to food resources, regardless of the sub.rdinate's sex. We hypothesized that white-tailed deer Odocoileus Virginian us temporally segregated at supplemental feedi ng sites b.sed on social rank (sub.rdinate: yearling males and adult females;dominant: adult males) and that segregation was affected b. phase of the b.eeding season and diel cycle. If deer temporally segregate according to social rank, we predicted that the resulting activity patterns would manifest in one social class b.ing relatively more susceptib.e to hunter-induced mortality. We used a multistate modeling approach to quantify temporal segregation and calculated the prob.b.lity that a feeding site was in a particular state during diurnal and nocturnal hours for each of the 3 phases of the b.eeding season. We determined that transition prob.b.lities differed b. season and diel cycle and dominant and sub.rdinate social classes clearly avoided each other, with b.eedi ng seas on, the prob.b.lity of a sub.rdi nate b.ing present during diurnal hours was *** more likely than a dominant b.ing present, b.t did not differ during nocturnal hours. There was no difference for dominants and sub.rdinates during diurnal or no cturnal hours during the b.eedi ng season .In the post-b.eedi ng season, sub.rdi nates were 1.7x more likely to occur at the feeding site than a dominant during diurnal hours b.t they did not differ during nocturnal hours. Our results indicate that dominance status influences temporal segregation at feeding sites and is affected b. the phase of the b.eeding season. Therefore, the resulti ng activity patterns may in crease sub.rdi nates' risk to human

关键词： competition multistate modeling predation risk supplemental feeding sites intraspecific temporal resource partitioning white-tailed deer

Role of nuclear factor κb.in multiple sclerosis and experimental autoimmune encephalomyelitis

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Neural Regeneration Research 2018年第9期13卷 1507-1515页

作者： Yuan Yue Sarrab.th stone Wensheng Lin Department of Neuroscience University of Minnesota Institute for Translational Neuroscience University of Minnesota

The transcription factor nuclear factor κb.NF-κb. plays major roles in inflammatory diseases through regulation of inflammation and cell *** sclerosis（MS） is a chronic inflammatory demyelinating and neurodegenerative disease of the central nervous system（CNS）.It has b.en shown that NF-κb.is activated in multiple cell types in the CNS of MS patients,including T cells,microglia/macrophages,astrocytes,oligodendrocytes,and ***,data from animal model studies,particularly studies of experimental autoimmune encephalomyelitis,have suggested that NF-κb.activation in these individual cell types has distinct effects on the development of *** this review,we will cover the current literature on NF-κb.and the evidence for its role in the development of MS and its animal model experimental autoimmune encephalomyelitis.

关键词： multiple sclerosis experimental autoimmune encephalomyelitis nuclear-factor κb T cell macrophage microglia astrocyte oligodendrocyte neuron

Storylines of family medicine Ⅰ:framing family medicine–history,values and perspectives

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Family Medicine and Community Health 2024年第S03期12卷 2-11页

作者： William b.Ventres Leslie A stone Kathleen T Rowland Richard H Streiffer michael D Macechko Julia A Roulier Jeffrey M b.rkan Larry A Green Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA Family and Preventive Medicine Rush Medical College of Rush UniversityChicagoIllinoisUSA College of Community Health Sciences University of AlabamaTuscaloosaAlabamaUSA UAMS Northwest Regional Campus Family Medicine Residency Program FayettevilleArkansasUSA UAMS North Central Regional Campus Family Medicine Residency Program BatesvilleArkansasUSA Family Medicine Brown University Warren Alpert Medical SchoolProvidenceRhode IslandUSA University of Colorado School of Medicine AuroraColoradoUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted b. individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅰ:framing family medicine—history,values,and perspectives’,the authors address the following themes:‘Notes on Storylines of Family Medicine’,‘Family medicine—the generalist specialty’,‘Family medicine’s achievements—a glass half full assessment’,‘Family medicine’s next 50 years—toward filling our glasses’,‘Four enduring truths of family medicine’,‘Names matter’,‘Family medicine at its core’and‘The ecology of medical care.’May readers find much food for thought in these essays.

关键词： glasses illustration Notes

The Part Count Tool (PaCT) for Design Concept Selection

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Modern Mechanical Engineering 2011年第2期1卷 13-24页

作者： Tarang Parashar Kerry Poppa Katie Grantham Lough Rob.rt b. stone Department of Mechanical and Aerospace Engineering Missouri University of Science and Technology School of Mechanical Industrial and Manufacturing Engineering Oregon State University Department of Engineering Management and Systems Engineering Misso

This paper presents a part count tool that predicts the part count for a particular product concept during the conceptual design phase. The part count tool will also aid in ranking the design concepts b. the criterion of numb.r of components for a product. This tool utilizes existing automated concept generation algorithms to generate the design concepts. It extracts the availab.e data from the Design Engineering Lab.Design Repository to determine an average numb.r of parts per component type in the repository and then calculates an average part count for new concepts. The part count tool also uses an algorithm to determine how to connect two non-compatib.e components through the addition of mutually compatib.e components. While emphasis is placed on the average parts per product in evaluating designs, the overall functional requirement of the product is also considered.

关键词： Mechanical Design Conceptual Design Design for Manufacturing and Assemb.y

The training process： Planning for strength-power training in track and field. Part 1： Theoretical aspects

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Journal of Sport and Health Science 2015年第4期4卷 308-317页

作者： b.ad H. DeWeese Guy Hornsb. Meg stone michael H. stone Exercise and Sport Science Center of Excellence Jor Sport Science and Coach Education East Tennessee State University Johnson City TN 37614 USA Kinesiology and Health Sciences Virginia Commonwealth University Richmond VA 23284 USA

The process of strength-power training and the sub.equent adaptation is a multi-factorial process. These factors range from the genetics and morphological characteristics of the athlete to how a coach selects, orders, and doses exercises and loading patterns. Consequently, adaptation from these training factors may largely relate to the mode of delivery, in other words, programming tactics. There is strong evidence that the manner and phases in which training is presented to the athlete can make a profound difference in performance outcome. This discussion deals primarily with b.ock periodization concepts and associated methods of programming for strength-power training within track and field. 2015 Production and hosting b. Elsevier b.V. on b.half of Shanghai University of Sport.

关键词： Periodization Strength-power training Track and field Training process

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Associations b.tween Pneumococcal Vaccinationand Adverse Outcomes in Patients with Suspected Acute Coronary Syndrome

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Advances in Infectious Diseases 2012年第4期2卷 122-134页

作者： Maliha Zahid Ish Singla Chester b. Good Roslyn A. stone Sunghee Kim michael J. Fine Ali F. Sonel Center for Healthy Equity and Research Promotion VA Pittsburgh Healthcare System Pittsburgh USA Department of Developmental b.ology University of Pittsburgh Pittsburgh USA Division of General Medicine Department of Medicine University of Pittsburgh Pittsburgh USA

b.ckground: Although pneumococcal vaccination prevents the most common pneumonia of b.cterial etiology, its associations without comes of Acute Coronary Syndrome (ACS) are unknown. Methods: This is a prospective cohort study of 1436 patients hospitalized with suspected ACS/non-ST elevation MI that were eligib.e for pneumococcal vaccination. Primary outcomes were death and sub.equent Myocardial Infarction (MI) within 6-months of the index hospitalization. We used Cox regression to assess associations b.tween pneumococcal vaccination and outcomes, adjusting for influenza vaccination and relevant clinical covariates. We also utilized propensity scores to adjust for potential confounding. Results: Overall, 937 (65.3%) patients received pneumococcal vaccination either prior to or during the index hospitalization. Unvaccinated patients had higher mortality (26.9% vs. 7.9%;p b.equent MI (7.4% vs. 3.5%;p = 0.06).Compared to patients who did not receive either pneumococcal or influenza vaccination, the unadjusted Hazard Ratio (HR) of death was significantly lower for those who received only pneumococcal vaccination (HR = 0.13;95% CI 0.07 - 0.23) or b.th vaccinations (HR = 0.66, 95% CI 0.47 - 0.92), and significantly higher for patients who received only influenza vaccination (HR = 1.88, 95% CI 1.33 - 2.64). The corresponding HRs and 95% CIs for sub.equent MI were 0.58 (95% CI 0.32 - 1.03) for pneumococcal vaccination only, 0.41 (95% CI 0.21 - 0.80) for b.th vaccinations and 0.97 (95% CI 0.48 - 1.95) for influenza vaccination alone. These remained unchanged after covariate or propensity score adjustment. Conclusions: Among patients hospitalized with suspected ACS, pneumococcal vaccination, with or without influenza vaccination, was associated with significantly lower risk of mortality within 6 months.

关键词： Pneumococcal Vaccination Acute Coronary Syndromes Outcomes

Storylines of family medicine Ⅺ:professional identity formation—nurturing one’s own story

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Family Medicine and Community Health 2024年第S03期12卷 99-108页

作者： William b.Ventres Leslie A stone Hamish J Wilson Sumi M Sexton David J Doukas Jessica P Cerdena David M Kelley michael D Fetters Jeffrey J Haney John J Frey III Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA General Practice and Rural Health University of Otago Dunedin School of MedicineDunedinNew Zealand Family Medicine Georgetown University School of MedicineWashingtonDistrict of ColumbiaUSA Family and Community Medicine Tulane University School of MedicineNew OrleansLouisianaUSA Family Medicine Residency Program Middlesex HealthMiddletownConnecticutUSA Family Medicine University of Michigan Medical SchoolAnn ArborMichiganUSA Medical Education and Clinical Sciences Washington State UniversitySpokaneWashingtonUSA Family Medicine and Community Health University of Wisconsin-Madison School of Medicine and Public HealthMadisonWisconsinUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted b. individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅺ:professional identity formation—nurturing one’s own story’,authors address the following themes:‘The social construction of professional identity’,‘On b.coming a family physician’,‘What’s on the test?—professionalism for family physicians’,‘The ugly doc-ling’,‘Teachers—the essence of who we are’,‘Family medicine research—it starts in the clinic’,‘Socially accountab.lity in medical education’,‘Personal philosophy and how to find it’and‘Teaching and learning with Storylines of Family Medicine’.May these essays encourage readers to find their own creative spark in medicine.

关键词： own b.coming professional