Balanced analgesia: what is it and what are its advantages in postoperative pain?

The concept of balanced analgesia was introduced to improve analgesic efficacy and reduce adverse effects. A large amount of clinical data has documented improved analgesia by combining different analgesics, but data on reducing adverse effects are inconclusive. Balanced analgesia should be used whenever possible, and future studies should be directed to define optimal combination regimens in individual surgical procedures.

Conditions for health: the Toronto Healthy City Model

"Governance initially developed at the city level, and as a horizontal coordination between multiple social agents, at its best is democratic, participatory and accountable to the stakeholders. The Healthy City approach is a model in bringing together different stakeholders and increasing participation in decision making. And only those cities that have understood this to be at the essence of the healthy city project have truly succeeded."1

Observations of a Protistan Disease Similar to QPX in Mercenaria mercenaria (Hard Clams) from the Coast of Massachusetts

During the summer and fall of 1995, in clam aquaculture leases at two locations on the coast of Massachusetts, significant mortalities were observed to occur primarily in 1½- to 2-year old hard clams (Mercenaria mercenaria, quahog) planted in the leases. Examination of hard clams from those leases suggested a parasite similar to QPX (Quahog Parasite Unknown), as described by Whyte, S. K., Cawthorn, R. J., and McGladdery, S. E. (1994, Can. Dis. Ag. Org. 19, 129-136), was responsible for the poor condition of affected clams and the resulting high mortality. In clam tissues, the QPX-like parasite formed thalli surrounded by a mucofilamentous net. Larger thalli underwent endosporulation producing sporangia that contained approximately 40 endospores. Rupture of the sporangium released the endospores into the surrounding tissue. Inflammatory response by the clam to infection was chronic, active, and granulomatous. The occurrence both of phagocytic multinucleated giant inflammatory cells and inflammatory encapsulation of parasites were commonly identified as part of the response. Moderately to severely infected clams showed significantly reduced growth and a poorer condition index as compared to uninfected or mildly infected clams. Copyright 1998 Academic Press. Copyright 1998 Academic Press