Online Volunteers : Knowledge Managers in Nonprofits

Peer-reviewed

Pharmacokinetics of Oxycodone and Paracetamol in the Elderly. Clinical Pharmacokinetic Study on Orthopaedic Surgical Patients and Healthy Volunteers

The proportion of elderly people over 65 years of age in Finland is expected to grow to over 25% by the 2025. It has been estimated that elderly people today consume nearly 40% of all drugs. Age brings about number of physiological changes that may affect the disposition, metabolism and excretion of drugs. The function of heart, lungs, liver and kidneys decreases even in healthy people, as they get older. The proportion of total body water decreases and the relative fat percentage increases. Also several other factors such as concurrent diseases, concomitant medication and nutritional factors have an effect on drug therapy in elderly. Age increases the risk of adverse drug reactions, which most often are dose-dependent. Despite all this there are not enough studies involving the elderly people and the elderly are most often excluded from clinical trials. Oxycodone is a strong opioid analgesic, which is used to treat moderate or severe pain. Paracetamol is a widely used nonopioid analgesic, which has become popular in the treatment of pain in many patient groups. In this series of studies the pharmacokinetics of oral and intravenous oxicodone as well as intravenous paracetamol in the elderly and young adult patients were investigated. Also a study investigating the interaction of oral antibiotic clarityhromycin, a known cytochrome P450 (CYP) 3A4 inhibitor, with oxycodone pharmacokinetics and pharmacodynamics in elderly and young healthy volunteers was carried out. The pharmacokinetics of oxycodone showed a clear age depency. Patients over 70 years had 50-80% higher mean exposure to oral oxycodone and a twofold greater plasma concentration than young adults 12 h after ingestion of the drug. Elderly patients had 40-80% greater exposure to intravenous oxycodone and patients over 80 years had over twofold greater plasma concentrations 8 h post dose than the young adults. The elderly patients had also greater exposure to intra venous paracetamol compared to young adults. Clarithromycin increased the exposure to oral oxycodone in both young and elderly volunteers. The elderly had marked interindividual variation in the pharmacokinetics and pharmacodynamics when clarithromycin was given concomitantly with oxycodone. Because the pharmacokinetics of oxycodone and intravenous paracetamol depend on the age of the subject, it is important to titrate the analgesic dose individually in the elderly.

Observations on the Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clinical Studies on Healthy Volunteers and Intensive Care Patients

Patients treated in intensive care units require sedation and analgesia. However, sedative drugs also have potential adverse effects, and there is no single ideal sedativeanalgesic drug for these patients. Dexmedetomidine is an apha2-adrenoceptor agonist licenced for sedation of intensive care patients and patients undergoing surgery and other invasive procedures. Several routes of parenteral administration (intravenous, intramuscular, subcutaneous and intranasal) have been utilized. In the present series of studies, the pharmacokinetics and pharmacodynamics of intranasally administered dexmedetomidine as well as the gastrointestinal effects of intravenous dexmedetomidine were determined in healthy volunteers. Pharmacokinetics of dexmedetomidine during long lasting, high-dose infusions were characterized in intensive care patients. The bioavailability of intranasal dexmedetomidine was relatively good (65%), but interindividual variation was large. Dexmedetomidine significantly inhibited gastric emptying and gastrointestinal transit. In intensive care patients, the elimination half-life of dexmedetomidine was somewhat longer than reported for infusions of shorter duration and in less ill patients or healthy volunteers. Dexmedetomidine appeared to have linear pharmacokinetics up to the studied dose rate of 2.5 μg/kg/h. Dexmedetomidine clearance was decreasing with age and its volume of distribution was increased in hypoalbuminaemic patients, resulting in a longer elimination half-life and context-sensitive half-time. Intranasally administered dexmedetomidine was efficacious and well tolerated, making it appropriate for clinical situations requiring light sedation. The clinical significance of the gastrointestinal inhibitory effects of dexmedetomidine should be further evaluated in intensive care patients. The possibility of potentially altered potency and effect duration should be taken into account when administering dexmedetomidine to elderly or hypoalbuminaemic patients.

Normal range values for thromboelastography in healthy adult volunteers

Thromboelastography (TEG®) provides a functional evaluation of coagulation. It has characteristics of an ideal coagulation test for trauma, but is not frequently used, partially due to lack of both standardized techniques and normal values. We determined normal values for our population, compared them to those of the manufacturer and evaluated the effect of gender, age, blood type, and ethnicity. The technique was standardized using citrated blood, kaolin and was performed on a Haemoscope 5000 device. Volunteers were interviewed and excluded if pregnant, on anticoagulants or having a bleeding disorder. The TEG® parameters analyzed were R, K, α, MA, LY30, and coagulation index. All volunteers outside the manufacturer’s normal range underwent extensive coagulation investigations. Reference ranges for 95% for 118 healthy volunteers were R: 3.8-9.8 min, K: 0.7-3.4 min, α: 47.8-77.7 degrees, MA: 49.7-72.7 mm, LY30: -2.3-5.77%, coagulation index: -5.1-3.6. Most values were significantly different from those of the manufacturer, which would have diagnosed coagulopathy in 10 volunteers, for whom additional investigation revealed no disease (81% specificity). Healthy women were significantly more hypercoagulable than men. Aging was not associated with hypercoagulability and East Asian ethnicity was not with hypocoagulability. In our population, the manufacturer’s normal values for citrated blood-kaolin had a specificity of 81% and would incorrectly identify 8.5% of the healthy volunteers as coagulopathic. This study supports the manufacturer’s recommendation that each institution should determine its own normal values before adopting TEG®, a procedure which may be impractical. Consideration should be given to a multi-institutional study to establish wide standard values for TEG®.

International volunteers at a Costa Rican organic farm : sheepish volunteers, proud tourists and unwitting developers

This thesis analyzes the practices and experiences of two groups of Canadian volunteers who visited the organic fanning and "alternative development" project ofFinca la Flor (FLF) in central Costa Rica. Using both participant observation and in-depth interviews with volunteers and other people involved with FLF, I examine volunteers' understandings of their involvement with the fann. I argue that three discursive fonnations are instrumental in shaping this particular volunteering encounter. Specifically, interpretation of these Canadian volunteers' experiences inspires the argument that the emerging practice of international volunteering (or voluntourism) exists at the intersection of discourses of development, volunteering and tourism, all of which both reflect and maintain problematic North-South relationships. The analysis shows that in spite ofFLF's construction as an (alternative / sustainable) international-development project, and in spite of volunteers' initial conceptualization of their trip as "volunteering," volunteers tend to act and describe their time at FLF in ways that look more like tourism than like volunteer labor or international development. Likewise, although FLF claims to principally be focused on alternative development, and merely to open up this authentic development space to volunteers for their participation, the organization in both practice and discourse seems primarily to construct a tourist experience and cater to the needs of foreigners as tourists. Discourses of development and volunteering do infonn the practices offann personnel and volunteers at FLF, but they become subordinated to the more dominant discourse of tourism as the volunteers' and fann management's ideals of development and volunteering capitulate to become focused on satisfying volunteers' (perceived or "real") touristic desires. The FLF participants I studied may have entered the encounter as volunteers, but they departed the site having been tourists.

Managing Volunteers in Canadian Community Sport Organizations

This study examined the use of human resource management (HRM) practices with volunteers in Canadian Community Sport Organizations (CSOs). Using the Volunteer Management Inventory (VMI; Cuskelly, Taylor, Hoye & Darcy, 2006), 219 leaders of associations in basketball, curling, ice hockey, skating, skiing, swimming, and volleyball participated in this study and identified current trends in HRM practices and perceived issues in the retention of volunteers. Data collected was analyzed using mean and descriptive statistics, T-tests, ANOVAs, and regression analyses. Results indicate that there is a varying use of HRM practices amongst the organizations, and also a significant correlation between the use of HRM practices and the retention of volunteers, particularly board members. Implications and future research directions are discussed regarding how HRM practices and principles may be applied to CSOs.

Report of the committee appointed to inquire what amendments are necessary to the Act granting bounties in land and extra pay to certain Canadian volunteers: January 11, 1817, read, and, together with the bill herewith reported, ordered to be printed. (1817)

Includes (p. 3-4) a letter from the Acting Secretary of War to the chairman of the committee dated Department of War, December 26th, 1816.

Volunteering and Social Capital: A Case Study of Older Hospital Volunteers in Southern Ontario

Volunteering as a form of social activity can facilitate older adults’ active aging through community engagement. The purpose of this qualitative case study was to understand the views on older adults’ volunteerism in a community hospital network in Southern Ontario. Utilizing in-depth interviews with 10 older volunteers (over the age of 65), document analysis, and a key informant interview, I explored their experiences of volunteering and social capital development at six hospitals in the network. Data analyses included open and axial coding, and conceptualization of the themes. Four major themes emerged from the data: reasons to volunteer, management’s influence, negative experiences of volunteering, and connections with others. The findings of this research emphasized older volunteers’ strong commitment and enthusiasm to support the hospital in their own communities, the power of volunteering to enhance the development of bonding, bridging, and linking social capital, and the influence of two major contextual factors (i.e. the Auxiliary Factor and the Change Factor) to facilitate or hinder older volunteers’ social capital development in the hospitals. Future research directions should focus on further unpacking the different degrees to which each type of social capital is developed, placing emphasis on the benefits of social capital development for volunteers in healthcare settings. The implications for practice include the targeted recruitment of older adults as healthcare volunteers while creating volunteer positions and environments in which they can develop social capital with their peer volunteers, hospital staff, patients, and people in surrounding communities. To sustain their existing dedicated long-term volunteers, in particular their Auxiliary groups, the community hospital network can enhance facilitating factors such as the Auxiliary Factor while mitigating the negative effects of the Change Factor. By developing social capital through volunteering in their own communities, older adults can engage in active aging, while participating in the development of an age-friendly community.

Letter (rough copy) written to Colonel Hope, commander of the Queen’s Volunteers from J.P. Bradley

Letter (rough copy) written to Colonel Hope, commander of the Queen’s Volunteers from J.P. Bradley offering his services (3 pages, handwritten). Bradley asks why he was not appointed to the new corps, Nov. 8, 1838.

Appointment of John B. Parkynn [Parkin] (J.P. Bradley’s brother) to be an Ensign of the 1st Company of the Royal Quebec Volunteers

Appointment of John B. Parkynn [Parkin] (J.P. Bradley’s brother) to be an Ensign of the 1st Company of the Royal Quebec Volunteers. This is signed by the Governor General, the Earl of Gosford and Governor General, Secretary J. Walcott, Nov. 27, 1837.