Fentanyl (sometimes spelled fentanil) is a synthetic opioid that is used as a painkiller. It also acts as a sedative. It has a short duration of action and a rapid onset. The two most common forms are patches that are put on the skin, and an intravenous solution. Paul Janssen developed Fentanyl in 1960. Fentanyl is about 120 times as potent as morphine; this means, much less Fentanyl is needed to get the same effect.
The effects of the intravenous solution can be seen after three to five minutes. In about twelve hours, the concentration in the bloodstream will have halved.
Fentanyl is also used as a recreational drug. This has led to thousands of overdose deaths each year from 2000 to 2015. Deaths have also resulted from improper medical use. Fentanyl has a relatively wide therapeutic index (270) which makes it a very safe surgical anesthetic when monitored carefully. Because it is so potent, finding the right dose to use requires great care: Fentanyl comes as a highly diluted solution. There is also a powder, but its use is impractical without advanced scientific equipment: The effective dose needed and a lethal dose of fentanyl powder placed next to each other would be difficult or impossible to differentiate with the naked eye.
Prescription drug abuse has become a widespread problem in the US, partially due to the myth that these drugs are safe simply because they’re prescribed by a doctor. According to the National Institute on Drug Abuse, 1 in 5 Americans has used a prescription drug for a non-medical purpose at least once. The problem tends to be most severe amount young people, with 1 in 12 high school seniors reporting recreational use of the opioid Vicodin in the year 2010 alone.
Fentanyl is often sought out by recreational users of less potent opioids like Vicodin or heroin who have already built up a tolerance to their drug of choice and are seeking a new way to experience the euphoric high associated with this class of intoxicants.
Opioid overdose is very dangerous due to the way these drugs affect the central nervous system, which controls the heart and respiratory system. As a depressant, opioids slow these essential functions down. If a person isn’t breathing enough and/or the heart isn’t able to pump enough blood to get a sufficient amount of oxygen to the brain, a condition called hypoxia can occur. This is simply a lack of oxygen to essential tissues, causing rapid cell death.
Fentanyl is an especially powerful sedative, so it’s likely for an individual who takes a high dose of the drug to fall asleep. While asleep, others may leave the individual alone and not notice that breathing has slowed or stopped.
Aube (river)
The Aube is a river in France. It is a right tributary of the Seine. The Aube department is named after the river.
The Aube river has a length of and a drainage basin with an area of .
Its average yearly discharge (volume of water which passes through a section of the river per unit of time) is at Arcis-sur-Aube in the Aube department.
The source of the Aube river is in the Langres Plateau, in the "commune" of Praslay, at an altitude of about , in the Haute-Marne department.
The Aube river flows through 2 regions, 4 departments and 80 "communes". It flows through the following "communes", among others:
Finally, it flows into the Seine river in the town of Marcilly-sur-Seine in the Marne department.
The main tributaries of the Aube river are:
Left tributaries:
Right tributaries:
Terza rima
Terza rima is a three-line rhyme scheme of Italian origin. The first line rhymes with the third one. The second line is free and can rhyme with a line in the next strophe.
Terza rima occurs in sonnets. Sonnets are often composed of two quatrains and two terza rimas, for example abba abba cdc dcd. This scheme can be found in many Italian, Spanish and Portuguese sonnets. This sonnet by the 16th century Portuguese poet Francisco de Sá de Miranda is a good example.
<poem>
"O sol é grande, caem co’a calma as aves,"
"do tempo em tal sazão, que sói ser fria;"
"esta água que d’alto cai acordar-m’-ia"
"do sono não, mas de cuidados graves."
"Ó cousas, todas vãs, todas mudaves,"
"qual é tal coração qu’em vós confia?"
"Passam os tempos vai dia trás dia,"
"incertos muito mais que ao vento as naves."
"Eu vira já aqui sombras, vira flores,"
"vi tantas águas, vi tanta verdura,"
"as aves todas cantavam d’amores."
"Tudo é seco e mudo; e, de mestura,"
"também mudando-m’eu fiz doutras cores:"
"e tudo o mais renova, isto é sem cura!"
</poem>
Usually terza rimas are linked to each other making long chain-like sequences. There is an extra line at the end of the sequence. The scheme of rhymes is: aba bcb cdc ded... xyx yzy z. Terza rimas are suitable for long poems. The best known example is The Divine Comedy by Dante Alighieri. Perhaps every child in Italy knows these lines by heart.
<poem>
"Nel mezzo del cammin di nostra vita"
"mi ritrovai per una selva oscura,"
"ché la diritta via era smarrita."
"Ahi quanto a dir qual era è cosa dura"
"esta selva selvaggia e aspra e forte"
"che nel pensier rinova la paura!"
"Tant’è amara che poco è più morte;"
"ma per trattar del ben ch’i’ vi trovai,"
"dirò de l’altre cose ch’i’ v’ ho scorte."
</poem>
Spanish poet Bernardo de Balbuena, who lived in Mexico, wrote a long poem in terza rima named "Grandeza mexicana"
<poem>
"Oh tú, heroica beldad, saber profundo,"
"que por milagro puesta a los mortales"
"en todo fuiste la última del mundo;"
"criada en los desiertos arenales,"
"sobre que el mar del sur resaca y quiebra"
"nácar lustroso y perlas orientales;"
"do haciendo a tu valor notoria quiebra,"
"el tiempo fue tragando con su llama"
"tu rico estambre y su preciosa hebra;"
</poem>
In Britain Robert Browning used terza rima in "The Statue and the Bust":
<poem>
"There ’s a palace in Florence, the world knows well,"
"And a statue watches it from the square,"
"And this story of both do the townsmen tell."
"Ages ago, a lady there,"
"At the furthest window facing the east,"
"Asked, “Who rides by with the royal air?”'
"The bridesmaids’ prattle around her ceased:"
"She leaned forth, one on either hand;"
"They saw how the blush of the bride increased."
</poem>
Percy Bysshe Shelley invented a sonnet built of fout terza rimas and a couplet. It rhymes aba bcb cdc ded ee. Shelley used it in "Ode to the Western Wind". It consists of five sonnets. Let us look at the first one.
<poem>
"O wild West Wind, thou breath of Autumn's being,"
"Thou, from whose unseen presence the leaves dead"
"Are driven, like ghosts from an enchanter fleeing,"
"Yellow, and black, and pale, and hectic red,"
"Pestilence-stricken multitudes: O thou,"
"Who chariotest to their dark wintry bed"
"The winged seeds, where they lie cold and low,"
"Each like a corpse within its grave, until"
"Thine azure sister of the Spring shall blow"
"Her clarion o'er the dreaming earth, and fill"
"(Driving sweet buds like flocks to feed in air)"
"With living hues and odours plain and hill:"
"Wild Spirit, which art moving everywhere;"
"Destroyer and preserver; hear, oh hear!"
</poem> American poet Robert Frost in his poem "Acquainted with the Night" used aba bcb cdc dad aa scheme.
Jan Kasprowicz, who translated Shelley's poem into Polish, used this scheme in a work by his own. It is called "Cisza wieczorna". ("Evening Silence").
Another form composed of terza rimas is a villanelle. It is made up of nineteen lines. It rhmymes acording to the scheme aba aba aba aba aba abaa. An example is "Do not go gentle into that good night" by Welsh poet Dylan Thomas.
Therapeutic index
The therapeutic index is a number that tells how safe it is to use a drug. It is obtained by dividing two numbers: the dose needed so that half of all individuals show the desired effect, and the dose which will kill half of all the individuals.
Geodetic datum