Outline and discuss the evolution of CSR Essay Example | Topics and Well Written Essays - 2500 words

Outline and discuss the evolution of CSR - Essay Example This paper explores the concept of Corporate Social Responsibility, tracing its evolution and how businesses implement it as well as how it affects them. II. Definitions of CSR Corporate Social Responsibility (CSR) may be perceived in a variety of ways depending on one’s perspective. One commonly accepted definition is as follows: â€Å"The continuing commitment by business to behave ethically and contribute to economic development while improving the quality of life of the workforce and their families as well as of local community and society at large.† - World Business Council for Sustainable Development, 2005 Another definition created by the European Commission (2003) is: â€Å"Responsible business practices that support the three principles of sustainable development: economic growth and prosperity, social cohesion and equity and environmental integrity and protection.† (p.5) III. Principles of CSR The United Nations is the main promoter of CSR. On December 31, 1999, then Secretary General Kofi Annan declared its principles at the World Economic Forum in Davos (Madrakhimova, 2013): 1. Human Rights – Commercial organizations should maintain support and respect for internationally recognized human rights in the creation of their standards of work. The rights to bargain collectively of workers must be upheld. Forced labour and child labour should be eliminated along with any form of discrimination in the workplace. 2. Ecology – Corporations should be conscious of the prevention of environmental problems and diligent in carrying out a more responsible attitude towards the care of the environment. They need to promote technologies and know-how in the reduction of negative impacts of some systems on the environment. 3. Anti-corruption – Corruption in all forms which include extortion, bribery and red tape must be prevented. 4. Legal responsibility – Legal frameworks bound in the territories where the businesses st and must be enforced. 5. Global responsibility – Compliance with international standards of social responsibility 6. Environmental Responsibility – collaboration of businesses and society in the rational use of natural resources, effective management of the environment and public health from the production of environmentally-friendly products. 7. Cultural and ethical responsibility – Compliance with relevant territorial cultural and ethical customs and traditions as well as moral norms followed by employees and other stakeholders. 8. Philantropic responsibility – support and development of the society and of individual marginal groups through voluntary participation in social programs and social and financial investment. IV. Benefits of CSR In a study of Lithuanian development of CSR practices, Spukiene & Urbonien (2011) report the following internal benefits in adopting CSR practices have been recognized: business sustainability; competitive advantage; e asier compliance with legislation; employee loyalty; attraction and retention of qualified employees; increase in productivity, quality and sales; financial improvement and access to capital; and reduction of costs. External benefits from adopting CSR practices were acknowledged as well: improved image and reputation; preservation of the environment; intangible benefits; contribution to Lithuania?s sustainable development; increased visibility; promotion of solidarity in the community; clients? loyalty; and

Philosophy Assignment Example | Topics and Well Written Essays - 750 words - 7

Philosophy - Assignment Example This statement proves the logical induction from the general premise. Inductive reasoning is also known as hypothesis construction because any conclusions made are based on educated predictions. The problem here is that there is an inherent bias in the search for the conclusion that supports the initial hypothesis. Humans are innately inclined to act in such ways, which is commonly referred to as confirmation bias. An argument is valid if it is impossible for its premises to be true while its conclusion is false. In other words, the conclusion must be true if the premises, whatever they may be, are true. An argument can be valid even though the premises are false. This article uses the example of an argument that uses a signal word within the premise. Specifically the term â€Å"Tea Party† is leveraged in the following statement: â€Å".Sen. Scott Brown has thrown his tea party supporters â€Å"under the bus† with his recent critiques of some Republican budget cut proposals, a movement leader said Friday.† This article uses a conclusion signal word which is indicated in the following statement. â€Å"Even as the economy slowly adds jobs, many Americans will remain unemployed for years on end†. The signal word here is unemployment and can be substituted with the term

Independent Study Jordanian Television Research Paper

Independent Study Jordanian Television - Research Paper Example is prohibited, as well as anything deemed to harm â€Å"the state’s reputation and dignity† (Library of Congress – Federal Research Division, 2006, 20). Fines, prosecutions, and also prison terms are often awarded, to keep the mass media under control. Informants and spies keep the government abreast of the nature of publications (on articles that are yet to be published, and on those that are already in circulation) and often the government applies regulations even before the article can be made public. The government sponsored media (in case of print media) is highly promoted, and television and radio face even more stringent regulations than the newspaper media; though the Internet functions somewhat more independently than all the others. In my article I will give an overview of the media in regards to the entire Middle East region, especially in Jordan; while focusing primarily on the television media in Jordan. My article will explore in detail the nature o f the television media that is functional in Jordan, in today’s context. Overview of the media in the Middle East: the Middle East regions have recently witnessed the free to air satellite TV launch, which is the latest addition in the still evolving media that we see there. Prior to the satellite TV era, it was mostly state owned newspapers, and other broadcasting services like radio and TV (terrestrial) that was used to broadcast news and programs.â€Å"Thus, Arab governments exercised a media monopoly and controlled the political narrative in the MENA region until the end of the 80s by shaping and influencing the opinions of the local population. More recently, technological innovations and the politics of marketing and advertising have resulted in a long-awaited democratization of the Arab media, opening new venues in the international market to the Arab press† (Kalliny, Arab Media: A Survey of an Imperfect Medium, 2010). The democratization of the Arab media has been a long drawn process, and

Lean Manufacturing--Mass Customization & Marketplace simulation Assignment

Lean Manufacturing--Mass Customization & Marketplace simulation - Assignment Example Knowing what the clients or rather what the customers want is very essential. Thus, the company should be in a position to understand the need for market segmentation. This is because, in today’s marketplace, it is necessary for a company to understand the need of market segmentation because of market fragmentation. In addition, the company should be in a position to explain how the marketers evaluate segments and choose a targeting strategy. In order to choose more segments and to target more clients, the company should be able to evaluate the potential for and success in the marketplace (Cagan, & Vogel, 2002). The process to which a computer producing company needs in order to have a good and continuous improvement is by knowing how much, and the quality and stability of computers the company supplies to the market. The computer company should be able to isolate and validate the goods they process, for instance: keyboards mouse, monitors, and processors among others. While in the market place target other markets. This particular computer company should not only focus on the current marketplace, and it should try to reach out to other markets for more profits. If the computer company invest in more designs and improve the quality and the designs of the machines it produces, it will be able to accomplish the market business stimulation it needs in the

Soybean Industry 5 Forces Evaluation Essay Example | Topics and Well Written Essays - 500 words

Soybean Industry 5 Forces Evaluation - Essay Example Monsanto is the leading producer of soybeans which controls a large portion of the marketplace due to their strategy of producing genetically engineer seeds. They have an advantage over another competitor because their seeds produce higher yield and the company has implemented strategies such as creating seeds that can be used for crops that will not generate new seeds, thus the buyer has to come back to Monsanto to purchase seeds for future crops. The strategy gives the company higher supplier power. Another opportunity for this leader soybean producer is the fact their seeds need a special pesticide which forces buyers to purchase the seeds and the pesticide from them. The soybean production takes place in China, India, the United States, Brazil, and Argentina. In South American particularly in Brazil, the soybean production poses a major threat to the natural habitat due to deforestation. The United States has several competitive advantages due to the subsidies offered to soybean farmers and the $1.00 per gallon incentive when soybean is used in the production of biodiesel or ethanol. Newer entrants into this industry outside the United States are not likely. An issue that poses a threat to new entrants is the rising prices of soybean are making this product less profitable than before. In a matter of a few years, the price of soybeans has gone from 22 cents a pound to the current price of 56.4 cents a pounds (Chapman, 2008). The final price of a biodiesel gallon utilizing soybeans is about a dollar and a half.

Amazing 7 Wonders of the World Essay Example for Free

Amazing 7 Wonders of the World Essay My name is Bshair, and I would like to tell you about one of the most amazing 7 wonders of the world I was given the opportunity to write about it. Not only because of the magnificent landmarks, but also because it has great history behind it, and it shows the roots of one of the most powerful empires the Incan Empire. Machu Picchu is the greatest Inca masterpiece. Incredibly daring and inventive, it was built on the most difficult, wild and inaccessible mountain area available. It is known world-wide not only for its impressive and unique ruins, but also for its unusual location on the edge of an abyss, from which one can appreciate the vigorous waters of the Urubamba river. I wonder how the Incas were able to carry the huge blocks of stone to the top of the mountain, we have no evidence that they used the wheel and build such a spectacular exponent of their wisdom and culture remains a mystery to this day. Of religious and military origin, the sacred city of Machu Picchu was enclosed by a wide wall. According to the archaeologist Alfredo, Machu Picchu can be divided into two major sections (the urban and the agricultural). Each part encloses two sub sections (the western and eastern) which are defined in relation to their topographic location. The agricultural section is divided into higher and lower ground. The high ground consists of five premises, the shrine of pile of stones marking a holy site and over 40 platforms. The low ground, meanwhile, comprises seven premises, four open areas and approximately 80 platforms. Some of the numerous agricultural terraces, which are placed in succession, are connected by stone stairways fitted in the walls, while others are linked by various set of steps forming corridors. The layout of the terraces and platforms is in perfect harmony with the mountains surrounding the site. Thus, the hillsides seem to be sculpted to harmonize with nature. There are 3 primary buildings in Machu Picchu they are the Intihuatana, the temple of the sun, and the room of the three windows. All the three rooms together are called the scared district of Machu Picchu. Legend tells that when a sensitive person touches their forehead to the Intihuatana stone it opens their vision in the spirit world. Finally, I Recommend people to visit this amazing place, I’m sure that they will be amazed and they will like what they see there, i would like to visit this amazing place my self some day, because it’s Something not to be missed.

Effect of Buprenorphine on Postoperative Pain Levels

Effect of Buprenorphine on Postoperative Pain Levels Katelyn Shultz Nurse Anesthesia ABSTRACT In recent years, buprenorphine has become an increasingly popular choice for managing opioid dependence; however, buprenorphine’s unique mechanism of action can make treating acute pain more complicated. In opioid-dependent patients managed with buprenorphine, would continuing buprenorphine therapy during the perioperative period affect postoperative pain levels? The research method for this study is a formal literature review. I predict that continuing buprenorphine throughout the perioperative period will improve postoperative pain levels in opioid-dependent patients maintained on buprenorphine. INTRODUCTION In recent years, buprenorphine has become an increasingly popular choice in the treatment of opioid dependence. Even though it is a partial mu agonist, buprenorphine is known to have high mu-receptor affinity. When buprenorphine is continued throughout the perioperative period, this property may reduce the effectiveness of other full mu agonist opioids. As a result, this pharmacological trait introduces an obstacle for successful treatment of acute surgical pain in the patient taking chronic buprenorphine. The clinician must choose the best option for this patient, to continue or discontinue buprenorphine therapy during the perioperative period. BACKGROUND AND SIGNIFICANCE It is imperative to establish evidence-based practice guidelines regarding the best method of acute pain management for patients taking chronic buprenorphine. As buprenorphine use increases, healthcare providers will encounter opioid-dependent patients taking chronic buprenorphine with higher frequency in the surgical setting.1 Although the positive outcomes of buprenorphine use are comprehensively researched and well documented, the evidence regarding the perioperative continuation or suspension of buprenorphine is limited and inconsistent. As a result, prescribers may avoid buprenorphine altogether, ultimately preventing more patients from receiving a potentially superior treatment. Perioperative is defined as the phase immediately prior, during, and immediately after a surgical procedure. Postoperative period is defined as the phase after a surgical procedure is performed. Buprenorphine maintenance therapy (BMT) is defined as a sustained dose of buprenorphine taken by an opioid-dependent patient for an indefinite period of time. Methadone maintenance therapy (BMT) is defined as a sustained dose of methadone taken by an opioid-dependent patient for an indefinite period of time. Full mu opioid agonists activate mu receptors until a maximum effect is reached or the receptor is fully activated. Methadone, morphine, and oxycodone are examples of full mu agonists. Partial mu opioid agonists bind to receptors and partially activate them, but not to the same degree as do full agonists. Partial mu agonists can also displace full mu agonists from receptors. Buprenorphine is a partial mu agonist. Patient-controlled analgesia (PCA) is any method of allowing a person in pai n to administer their own pain relief. METHODS The research method for this study was a formal literature review. The purpose of this study was to answer the question, in opioid-dependent patients managed with buprenorphine, would continuing buprenorphine therapy during the perioperative period affect postoperative pain levels? I searched the database SuperSearch. The key terms for this search were (pain management OR treatment), buprenorphine, and (perioperative OR intraoperative OR postoperative) using the Boolean operator AND. I limited results to peer-reviewed academic journal articles published in English from 2004-2014. Initial results were refined using the inclusion criteria of patients maintained on buprenorphine therapy prior to surgery and perioperative pain management, and the exclusion criteria of animal studies and buprenorphine administration techniques: epidural, intrathecal, perineural, subcutaneous, and transdermal. REVIEW OF THE LITERATURE The purpose of these studies is to examine perioperative acute pain management in opioid-tolerant patients taking BMT. The type of studies include a retrospective cohort study, literature reviews, and case reports examining a population of people taking chronic buprenorphine. Buprenorphine may be a more preferable method than methadone for chronic opioid replacement therapy. The use of buprenorphine has been associated with improvement in education, social life, and toxicological conditions when compared to methadone.1 Buprenorphine is also perceived to have less adverse effects and social stigma than methadone.2 In addition, buprenorphine’s full opioid agonist effects are lower compared to methadone, improving its safety profile.3 Buprenorphine may also induce less hyperalgesia than full agonists, although this has yet to be confirmed.2 In support of this statement, however, Koppert et al4 found that the antihyperalgesic effects of buprenorphine were stronger and of longer duration as compared with the pure mu receptor agonist studied in the same model. Though some researchers recommend a transition from buprenorphine to a full mu agonist preoperatively, an interruption in BMT is not ideal. A drug holiday or transition to other chronic opioids, such as methadone, prior to surgery may lead to simplified sedation techniques; however, it is time consuming and unnecessary, and alternatives should be considered.1 It is best that patients with opioid dependence be in some early withdrawal before initiating treatment with buprenorphine.5 As a result, when a patient transitioned to methadone prior to surgery returns to their previous dose of buprenorphine postoperatively, withdrawal may occur.1 Additionally, for patients switched from BMT to MMT preoperatively, methadone must be ceased for at least 36 hours and the patient should experience mild withdrawal symptoms before buprenorphine is restarted.6 In contrast to these recommendations, the retention of buprenorphine was found to be better in heroin addicts with less morbidity if buprenorp hine was not rapidly withdrawn, but continued for up to 350 days.5 When chronic buprenorphine doses were continued throughout perioperative period, patients were able to achieve good pain control with additional opioids and/or additional buprenorphine doses. In a small series of 5 patients, adequate pain control was achieved when other full mu agonist opioids were given as needed in addition to the patient’s usual daily dose of buprenorphine.7 In another study,8 the patient achieved adequate pain control on postoperative day 1 and 2 with a total daily buprenorphine dose of 72 mg, and was able to successfully and comfortable taper to her baseline dose of 24 mg/d by day 11. Furthermore, Jones et al9 reported the buprenorphine-managed patient scored 0 out of 10 on all 6 post morphine-PCA pain assessments, and 0 to 5 out of 10 on all post discharge pain assessments while taking buprenorphine and oxycodone/acetaminophen. Only 1 study10 reported severe postoperative pain control with the continuation of buprenorphine during the perioperative period. The study10 highlighted a case report for one patient with Type I Chiari malformation receiving buprenorphine for chronic pain who underwent two identical surgical procedures. For the first procedure, the patient’s usual dose of buprenorphine was continued throughout the perioperative period, and a full mu agonist was used for postoperative pain.10 The patient reported severe postoperative pain after this procedure.10 This information is limited, however, by self-report. No documentation was obtained from the outside hospital where the first procedure was performed.10 The author is a representative for the hospital where the second procedure was performed.10 For the second procedure, the patient’s buprenorphine was discontinued 5 days prior to surgery, and the patient was transitioned to a full opioid agonsist.10 Again, the patient’s p ostoperative pain was managed with a full opioid receptor agonist.10 Though the patient reported acceptable pain control on postoperative day 1, the patient’s pain was reported at 7 to 8/10 immediately after surgery.10 Although some researchers suggest that buprenorphine decreases full mu agonist opioid’s effectiveness, many found the addition of full mu agonists in the perioperative setting to be beneficial for buprenorphine-maintained patients. Buprenorphine’s long half-life, high opioid receptor affinity, partial agonist activity, and slow dissociation from the mu receptor may reduce analgesic effectiveness of full mu opioid agonists; however, the data does not support the commonly held belief that high dose BMT will interfere with the activity of full mu agonist opioids given for the relief of postoperative pain.6 Morphine has been shown to be an effective breakthrough medication to control postoperative pain in buprenorphine-maintained patients.11 In a retrospective cohort study, Macintyre et al6 confirmed BMT patients who were not given buprenorphine the day after surgery had significantly higher (P=.02) PCA morphine equivalent requirements in the first 24 hours after surgery co mpared with those who were given their usual dose of buprenorphine. In another uncontrolled comparison of BMT and MMT groups, researchers12 found that the first 24 hour postoperative PCA opioid requirements were lower for BMT and MMT groups when maintenance drugs were continued compared with BMT and MMT groups whose maintenance drugs had been ceased perioperatively. Despite the fact that one report6 showed a reduction in whole brain mu receptor availability with high doses of buprenorphine, several studies demonstrated that there is no ceiling effect for the analgesic properties of buprenorphine, only for an opioid’s euphoric effects and respiratory depression. It has been shown that buprenorphine attenuates the effects of additional opioid agonists rather than exert an absolute ceiling effect, and this minimizes euphoric properties of concurrently administered opioids and discourages the likelihood of ongoing opioid abuse.2 Macintyre et al6 also revealed that PCA opioid requirements were lower when BMT was continued after surgery, implying that buprenorphine may still have analgesic effects. Walsh et al13 documented no ceiling effect for analgesia in patients that received sublingual buprenorphine up to 32 mg. As there are no additional opioid effects with escalating doses, this property limits abuse potential and minimizes respiratory d epression with high doses.2 In a study of 20 volunteers, Dahan et al14 confirmed buprenorphine’s ceiling effect on respiratory depression, but not on its analgesic effects. As buprenorphine demonstrates a ceiling effect for respiratory depression, it is safe for outpatient use in high doses; however, when used in conjunction with sedatives, a synergistic effect in respiratory depression may occur. One case report8 verified that a high daily dose of buprenorphine (72 mg) was safely used as an outpatient dose, though no other respiratory depressants were used. Combining benzodiazepines with buprenorphine can exert a synergistic effect on the central nervous system resulting in sedation and respiratory depression.11 Deaths from buprenorphine have been reported, but it has been suggested that these deaths predominantly occurred as a result of prolonged respiratory depression when administered with sedatives, particularly benzodiazepines.2 There is no consensus on recommendations regarding acute pain management for buprenorphine-maintained patients presenting to the perioperative setting and more research is needed. Some articles2,5,11 recommend the cessation of buprenorphine preoperatively and conversion to a full opioid agonist throughout the perioperative period. Conversely, others1,2,5,8 demonstrate successful pain management in the acute pain setting with divided daily and/or additional doses of buprenorphine. The majority of researchers,2,3,5,9,11,15 however, support the continuation of usual buprenorphine maintenance therapy with the addition of full mu agonist opioid analgesics for effective perioperative pain control. There are no recommendations based on high level evidence,15 and data is sparse regarding the best method of treatment for pain in the opioid-dependent population.5 Regardless of point of view, most studies agree that additional research regarding acute pain management for patients taking chronic buprenorphine is urgently needed.5,10,11 DISCUSSION It is clear that buprenorphine is a better alternative than methadone for the treatment of opioid dependence. Associated with less respiratory depression and a lower abuse profile, buprenorphine is a safer medication than methadone and can be used without difficulty in outpatient therapy. With a long half-life and slow dissociation time, buprenorphine can also be dosed less frequently. Buprenorphine has also been known to cause less side effects than methadone. All of these features can increase adherence to opioid replacement therapy by allowing the opioid-dependent patient a less restrictive lifestyle. There is a great deal of uncertainty regarding the best method for treating acute surgical pain in patients taking chronic buprenorphine. There are multiple recommendations regarding perioperative pain management and BMT; however, most methods are developed from the results of uncontrolled studies with very small sampling sizes. Consequently, few are able to establish actual significance in their findings. Without concrete evidence, concise standard recommendations are difficult to establish. CONCLUSION Based on the literature, the continuation of BMT during the perioperative period with the addition of short acting full mu opioids and/or additional buprenorphine doses is the best approach to treating acute surgical pain. For future research, more controlled studies with larger sample sizes are needed in order to confirm the best method of acute pain management in the surgical setting for patient’s taking chronic buprenorphine. References Wasson M, Beirne O. Buprenorphine therapy: an increasing challenge in oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;(2):142. Available from: Academic OneFile, Ipswich, MA. Accessed June 3, 2014. Roberts D, Meyer-Witting M. High-dose buprenorphine: perioperative precautions and management strategies. Anaesth Intensive Care. February 2005;33(1):17-25. Available from: MEDLINE, Ipswich, MA. Accessed June 10, 2014. Bryson E, Lipson S, Gevirtz C. Anesthesia for Patients on Buprenorphine. Anesthesiol Clin. January 1, 2010;28(Perioperative Pharmacotherapy):611-617. Available from: ScienceDirect, Ipswich, MA. Accessed June 3, 2014. Koppert W, Ihmsen H, Korber N, et al. Different profiles of buprenorphineinduced analgesia and antihyperalgesia in a human pain model. Pain 2005;118(1–2):15–22. Cited by: Vadivelu N, Anwar M. Buprenorphine in Postoperative Pain Management. Anesthesiol Clin. January 1, 2010;28(Perioperative Pharmacotherapy):601-609. Available from: ScienceDirect, Ipswich, MA. Accessed June 3, 2014. Vadivelu N, Mitra S, Kaye A, Urman R. Perioperative analgesia and challenges in the drug-addicted and drug-dependent patient. Best Pract Res Clin Anaesthesiol. March 2014;28(1):91. Available from: Supplemental Index, Ipswich, MA. Accessed June 10, 2014. Macintyre P, Russell R, Usher K, Gaughwin M, Huxtable C. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care. March 2013;41(2):222-230. Available from: Academic Search Premier, Ipswich, MA. Accessed June 3, 2014. Kornfield H, Manfredi L. Effectiveness of full agonist opioids in patients stabilized on buprenorphine undergoing major surgery: a case series. Am J Ther 2010;17:523-528. Cited by: Huxtable C, Roberts L, Somogyi A, Macintyre P. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care. September 2011;39(5):804-823. Available from: Academic Search Premier, Ipswich, MA. Accessed June 3, 2014. Book S, Myrick H, Malcolm R, Strain E. Buprenorphine for postoperative pain following general surgery in a buprenorphine-maintained patient. Am J Psychiatry. June 2007;164(6)Available from: PsycINFO, Ipswich, MA. Accessed June 3, 2014. Jones H, Johnson R, Milio L. Post-cesarean pain management of patients maintained on methadone or buprenorphine. Am J Addict. May 2006;15(3):258-259. Available from: MEDLINE, Ipswich, MA. Accessed June 3, 2014. Chern S, Isserman R, Chen L, Ashburn M, Liu R. Perioperative Pain Management for Patients on Chronic Buprenorphine: A Case Report. J Anesth Clin Res. October 2012;3(10):1. Available from: Supplemental Index, Ipswich, MA. Accessed June 3, 2014. Vadivelu N, Anwar M. Buprenorphine in Postoperative Pain Management. Anesthesiol Clin. January 1, 2010;28(Perioperative Pharmacotherapy):601-609. Available from: ScienceDirect, Ipswich, MA. Accessed June 3, 2014. Russell R, Usher K, Macintyre PE. A comparison of postoperative opioid requirements and effectiveness in methadone- and buprenorphine-maintained patients. Anaesth Intensive Care. 2011;39:726-727. Cited by: Huxtable C, Roberts L, Somogyi A, Macintyre P. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care. September 2011;39(5):804-823. Available from: Academic Search Premier, Ipswich, MA. Accessed June 3, 2014. Walsh SL, Preston KL, Stitzer ML, et al. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569–80. Cited by: Vadivelu N, Anwar M. Buprenorphine in Postoperative Pain Management. Anesthesiol Clin. January 1, 2010;28(Perioperative Pharmacotherapy):601-609. Available from: ScienceDirect, Ipswich, MA. Accessed June 3, 2014. Dahan A, Yassen A, Romberg R, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627–32. Cited by: Vadivelu N, Anwar M. Buprenorphine in Postoperative Pain Management. Anesthesiol Clin. January 1, 2010;28(Perioperative Pharmacotherapy):601-609. Available from: ScienceDirect, Ipswich, MA. Accessed June 3, 2014. Huxtable C, Roberts L, Somogyi A, Macintyre P. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care. September 2011;39(5):804-823. Available from: Academic Search Premier, Ipswich, MA. Accessed June 3, 2014. 1