Hence, one can speculate that selection of opioids is driven by local traditions in medical practice rather than rational pharmacotherapy. This is illustrated in Table 1 using data from ‘The International Narcotics Control Board’. In fact major variability between consumption of different opioids between countries is seen, even though they share borders and their populations are thought to have the same genetic and cultural background. In head to head comparisons, most studies have failed to show relevant differences between drugs on a population level. Randomized studies provide little evidence that, at equi-analgesic doses, commonly used opioids differ markedly in their side effects. Although opioids have many side effects and their use has been associated with dependence, increasing misuse and mortality, no other strong analgesics can substitute for these drugs. Pain is the most common reason for individuals seeking medical care in the Western World and opioids are increasingly used to treat different types of pain. In the end this will reduce pain and side effects, leading to improved quality of life for the patient and reduce the exploding pain related costs. We recommend that this recognition is used to individualize treatment in difficult cases allowing physicians to have a wide range of treatment options. We provide evidence that individuals respond differently to opioids, and that general differences between classes of opioids exist. In this review we highlight differences between opioids in human studies from a pharmacological, experimental, clinical and health economics point of view. Therefore it is important to have an armamentarium of strong analgesics in clinical practice to ensure a personalized approach in patients who do not respond to standard treatment. Although this approach is recognized as cost-effective in most cases there is solid evidence that, on an individual patient basis, opioids are not all equal. Hence, recommendations of the regulatory authorities have been driven by costs with a general tendency in many countries to restrict physician's use of opioids to morphine. Solve puzzles, gather clues, and communicate with the most temperamental artificial intelligence ever designed.Īll rights reserved by CBE software s.r.o.Clinical studies comparing the response and side effects of various opioids have not been able to show robust differences between drugs.Utilize an ingenious MOBOT – a mobile robot designed for planetary exploration to investigate remote solar systems.Travel to six unique planets and uncover their secrets.Not only is your own survival at stake, but you need to find out what happened to the crew and why you alone survived. To make matters worse, the probe is severely damaged by a disastrous impact with a passing meteoroid swarm. Once there you learn from the ship’s AI that not only have you been asleep for decades, but you are also the last surviving member of the probe’s crew. Disoriented, you rush to the control room searching for answers. But why you are there is an elusive memory. As your surroundings come into focus, you realize you were deep in cryogenic sleep on a vast space probe. Now, imagine being jolted awake by an emergency alarm. Yet somehow, everything has gone terribly wrong… Everything was perfectly planned and success was certain. Only the most prominent scientists were selected and trained to ideally represent planet Earth. It was designed and equipped to be ideally suited for the ultimate challenge: to meet and study extraterrestrial sentient life-forms. No expense was spared in the construction of a massive space probe. Reaction was immediate and a mission plan was conceived. As all earthly observatories turned their attention towards this new discovery, a signal of artificial origin is detected from deep within the system. But are they prepared for what they will find?Īfter countless years of careful space observation, the enormous telescope Chandra 17 suddenly locates a solar system quite similar to our own. Together, this unlikely trio will explore the mysteries of this solar system. Her only companions are J.U.L.I.A., the space probe’s artificial intelligence and Mobot, a huge reconnaissance robot. Now Rachel is alone, orbiting an unknown planet. She is a member of an elite group of scientists, chosen to embark on one of the most critical missions ever conceived on Earth. The story centers on Rachel Manners, a 35 year old astrobiologist. J.U.L.I.A.: Among the Stars is an innovative narrative driven adventure game which is being developed due to overwhelming support from a successful crowdfunding campaign. J.U.L.I.A.: Among the Stars comes with a bonus standalone puzzle game J.U.L.I.A.: Untold.
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