Prescribing Medications for Chronic Pain Management: The State of Education in Florida Medical Schools and Residency Programs

The purpose of this study was to assess the state of chronic, non-cancer pain management education in Florida medical schools and residency programs. Surveys were developed and distributed to Florida allopathic and osteopathic medical schools. One survey was specific to students and residents and one to faculty. Confidence in their general education, as well as in treating patients with chronic, non-cancer pain, was measured. A majority of medical students and residents (59.5%), in addition to a majority of faculty (58.1%), agreed or strongly agree that more clinical time needs to be dedicated to chronic, non-cancer pain management education. Students, residents, and faculty suggested offering more lectures, online modules, workshops, and clinical scenarios as ways to improve the current educational environment. Results demonstrate that while Florida medical schools and residency programs provide education on chronic, non- cancer pain management, there is still room for improvement. Increased communication between institutions and standardizing competencies related to pain management may prove beneficial

Rendimento de grãos de soja: efeito do espaçamento e da densidade.

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Pre-Emptive Endoluminal Negative Pressure Therapy at the Anastomotic Site in Minimally Invasive Transthoracic Esophagectomy (the preSPONGE Trial): Study Protocol for a Multicenter Randomized Controlled Trial

Introduction: Anastomotic leakage (AL) accounts for a significant proportion of morbidity following oesophagectomy. Endoluminal negative pressure (ENP) therapy via a specifically designed polyurethane foam (EsoSponge®, B.Braun Medical, Melsungen, Germany) has become the standard of care for AL in many specialized centres. The prophylactic (pENP) application of this technique aims to reduce postoperative morbidity and is a novel approach which has not yet been investigated in a prospective study. The aim of this study is therefore to assess the effect of pENP at the anastomotic site in high-risk patients undergoing minimally invasive transthoracic Ivor Lewis oesophagectomy. Methods and analysis: The study design is a prospective, multi-centre, two-arm, parallel-group, randomised controlled trial and will be conducted in two phases. Phase one is a randomised feasibility and safety pilot trial involving 40 consecutive patients. After definitive sample size calculation, additional patients will be included accordingly during phase two. The primary outcome of the study will be the postoperative length of hospitalization until reaching previously defined “fit for discharge criteria”. Secondary outcomes will include postoperative morbidity, mortality and postoperative AL-rates based on 90-day follow-up. A confirmatory analysis based on intention-to-treat will be performed. Ethics and dissemination: The ethics committee of the University of Zurich approved this study (2019-00562), which has been registered with ClinicalTrials.gov on 14.11.2019 (NCT04162860) and the Swiss National Clinical Trials Portal (SNCTP000003524). The results of the study will be published and presented at appropriate conferences

Effect of vessel wettability on the foamability of "ideal" surfactants and "real-world" beer heads

The ability to tailor the foaming properties of a solution by controlling its chemical composition is highly desirable and has been the subject of extensive research driven by a range of applications. However, the control of foams by varying the wettability of the foaming vessel has been less widely reported. This work investigates the effect of the wettability of the side walls of vessels used for the in situ generation of foam by shaking aqueous solutions of three different types of model surfactant systems (non-ionic, anionic and cationic surfactants) along with four different beers (Guinness Original, Banks’s Bitter, Bass No 1 and Harvest Pale). We found that hydrophilic vials increased the foamability only for the three model systems but increased foam stability for all foams except the model cationic system. We then compared stability of beer foams produced by shaking and pouring and demonstrated weak qualitative agreement between both foam methods. We also showed how wettability of the glass controls bubble nucleation for beers and champagne and used this effect to control exactly where bubbles form using simple wettability patterns

The Mesozoic along-strike tectono-metamorphic segmentation of Longmen Shan (eastern Tibetan plateau)

The Longmen Shan belt (eastern border of the Tibetan plateau) constitutes a tectonically active region as demonstrated by the occurrence of the unexpected 2008 Mw 7.9 Wenchuan and 2013 Mw 6.6 Lushan earthquakes in the central and southern parts of the belt respectively. These events revealed the necessity of a better understanding of the long‐term geological evolution of the belt and its effect on the present dynamics and crustal structure. New structural and thermobarometric data offer a comprehensive dataset of the paleo‐temperatures across the belt and P‐T estimates for low‐grade metamorphic domains. In the central Longmen Shan, two metamorphic jumps of 150‐200°C, 5‐6 kbar and ~50 °C, 3‐5 kbar acquired during the Early Mesozoic are observed across the Wenchuan and Beichuan faults respectively, attesting to their thrusting movement and unrevealing a major decollement between the allochtonous Songpan‐Garze metasedimentary cover (at T > 500°C) and the autochtonous units and the basement (T < 400°C). In the southern Longmen Shan, the only greenschist‐facies metamorphism is observed both in the basement (360 ± 30°C, 6 ± 2 kbar) and in the metasedimentary cover (350 ± 30°C, 3 ± 1 kbar). Peak conditions were reached at c. 80‐60 Ma in the basement and c. 55‐33 Ma in the cover, c. 50 Ma after the greenschist‐facies metamorphic overprint observed in the central Longmen Shan (c. 150‐120 Ma). This along‐strike metamorphic segmentation coincides well with the present fault segmentation and reveals that the central and southern Longmen Shan experienced different tectono‐metamorphic histories since the Mesozoic