Trauma and acute care surgeons report prescribing less opioids over time.

IntroductionConfronted with the opioid epidemic, surgeons must play a larger role to reduce risk of opioid abuse while managing acute pain. Having a better understanding of the beliefs and practices of trauma and acute care surgeons regarding discharge pain management may offer potential targets for interventions beyond fixed legal mandates.MethodsAn Institutional Review Board-approved electronic survey was sent to trauma and acute care surgeons who are members of the American Association for the Surgery of Trauma, and trauma and acute care surgeons and nurse practitioners at a Level 1 trauma center in February 2018. The survey included four case-based scenarios and questions about discharge prescription practices and beliefs.ResultsOf 66 respondents, most (88.1%) were at academic institutions. Mean number of opioid tablets prescribed was 20-30 (range 5-90), with the fewest tablets prescribed for elective laparoscopic cholecystectomy and the most for rib fractures. Few prescribed both opioid and non-opioid medications (22.4% to 31.4 %). Most would not change the number/strength of medications (69.2%), dose (53.9%), or number of tablets of opioids (83.1%) prescribed if patients used opioids regularly prior to their operation. The most common factors that made providers more likely to prescribe opioids were high inpatient opioid use (32.4%), history of opioid use/abuse (24.5%), and if the patient lives far from the hospital (12.9%). Most providers in practice >5 years reported a decrease in opioids (71.9%) prescribed at discharge.ConclusionTrauma and acute care surgeons and nurse practitioners reported decreasing the number/amount of opioids prescribed over time. Patients with high opioid use in the hospital, history of opioid use/abuse, or who live far from the provider may be prescribed more opioids at discharge.Level of evidenceLevel IV

The molecular characterization of mutations induced in Mutator lines at the Bronzel and Shrunken loci in maize

Restriction maps, of Shrunken (Sh) alleles in two standard maize lines, Q60 and B70, were determined by restriction endonuclease digestion and Southern blot hybridization. A comparison of these maps with previously determined restriction maps of Sh alleles from three different maize lines showed that restriction endonuclease target sites were highly conserved within the promoter and transcription unit. However, the region adjacent to the polyadenylation site contained a high degree of restriction fragment polymorphism. This comparison enabled us to determine that four sh mutations induced in Mutator lines were caused by DNA insertions into the 5[superscript]\u27 region of the Sh gene. In addition to an insertion at the 5[superscript]\u27 region of the gene, one mutant contained another insertion at the 3[superscript]\u27 terminus. Southern blot hybridization data showed that only two of the five insertions were structurally related to Mu 1 or Mu 1.7 elements, which suggests that transposable DNA, other than Mu 1 or Mu 1.7 is involved in Mutator activity. One of these insertions was molecularly cloned and, through Southern blot hybridization, shown to have no sequence homology with the entire Mu 1 element. Further analysis is required to determine what role, if any, these elements have in the Mutator system. The analysis of mutations induced in Mutator lines was continued by analyzing two bronzel mutations, bz1-Mum3 and bz1-Mum6. A 1.4 kb insertion structurally similar to Mu 1 caused the bz1-Mum3 mutation, whereas a smaller (960 bp) insertion caused the bz1-Mum6 mutation. Molecular cloning of this smaller insertion (Mu S) showed that it contained the terminal inverted repeats of Mu 1 but was missing a portion of the Mu 1 internal region, indicating that Mu S was a deletion derivative of Mu 1

The Local Environments of Core-Collapse SNe within Host Galaxies

We present constraints on core-collapse supernova progenitors through observations of their environments within host galaxies. This is achieved through 2 routes. Firstly, we investigate the spatial correlation of supernovae with host galaxy star formation using pixel statistics. We find that the main supernova types form a sequence of increasing association to star formation. The most logical interpretation is that this implies an increasing progenitor mass sequence going from the supernova type Ia arising from the lowest mass, through the type II, type Ib, and the supernova type Ic arising from the highest mass progenitors. We find the surprising result that the supernova type IIn show a lower association to star formation than type IIPs, implying lower mass progenitors. Secondly, we use host HII region spectroscopy to investigate differences in environment metallicity between different core-collapse types. We find that supernovae of types Ibc arise in slightly higher metallicity environments than type II events. However, this difference is not significant, implying that progenitor metallicity does not play a dominant role in deciding supernova type.Comment: to appear in Proceedings of IAU 279 "Death of Massive Stars: Supernovae and Gamma-ray Bursts

Gender Politics and Secure Services For Women: Reflections on a study of staff understandings of challenging behaviour.

This paper discusses the findings of a Q methodological study that investigated the complexity of professional understandings of (attitudes towards) residents in a secure unit for women with learning disabilities and challenging behaviours. Particular attention is afforded to the critical debate regarding women in psychiatric and secure care, including the significant contribution made to this literature by feminist perspectives. A multiprofessional group of staff (n = 38) participated in the study and nine distinct accounts of women's challenging behaviour are described. Despite a considerable amount of recent policy concern with the position of women in psychiatric services, the findings of this research suggest that many front line staff are reluctant to highlight gender in their explanations of women's behaviour. This supports the assertion by Williams et al. (2001), who were involved in the National Gender Training Initiative (NGTI), that most critical theorizing about women's mental health has had minimal impact at the level of individuals’ understandings of these important issues. This state of affairs suggests a powerful case for the expansion of staff training as provided in the NGTI, which makes gender central to understanding and emphasizes feminist perspectives

Sensitivity to Timing and Order in Human Visual Cortex

Visual recognition takes a small fraction of a second and relies on the cascade of signals along the ventral visual stream. Given the rapid path through multiple processing steps between photoreceptors and higher visual areas, information must progress from stage to stage very quickly. This rapid progression of information suggests that fine temporal details of the neural response may be important to the how the brain encodes visual signals. We investigated how changes in the relative timing of incoming visual stimulation affect the representation of object information by recording intracranial field potentials along the human ventral visual stream while subjects recognized objects whose parts were presented with varying asynchrony. Visual responses along the ventral stream were sensitive to timing differences between parts as small as 17 ms. In particular, there was a strong dependency on the temporal order of stimulus presentation, even at short asynchronies. This sensitivity to the order of stimulus presentation provides evidence that the brain may use differences in relative timing as a means of representing information.Comment: 10 figures, 1 tabl

Rhodium Pyrazolate Complexes as Potential CVD Precursors

Reaction of 3,5-(CF3)(2)PzLi with [Rh(mu-Cl)(eta(2)-C2H4)(2)](2) or [Rh(mu-Cl)(PMe3)(2)](2) in Et2O gave the dinuclear complexes [Rh(eta(2)-C2H4)(2)(mu-3,5-(CF3)(2)-Pz)](2) (1) and [Rh-2(mu-Cl)(mu-3,5-(CF3)(2)-Pz) (PMe3)(4)] (2) respectively (3,5-(CF3)(2)Pz = bis-trifluoromethyl pyrazolate). Reaction of PMe3 with [Rh(COD)(mu-3,5-(CF3)(2)-Pz)](2) in toluene gave [Rh(3,5-(CF3)(2)-Pz)(PMe3)(3)] (3). Reaction of 1 and 3 in toluene (1 : 4) gave moderate yields of the dinuclear complex [Rh(PMe3)(2)(mu-3,5-(CF3)(2)-Pz)](2) (4). Reaction of 3,5-(CF3)(2)PzLi with [Rh(PMe3)(4)]Cl in Et2O gave the ionic complex [Rh(PMe3)(4)][3,5-(CF3)(2)-Pz] (5). Two of the complexes, 1 and 3, were studied for use as CVD precursors. Polycrystalline thin films of rhodium (fcc-Rh) and metastable-amorphous films of rhodium phosphide (Rh2P) were grown from 1 and 3 respectively at 170 and 130 degrees C, 0.3 mmHg in a hot wall reactor using Ar as the carrier gas (5 cc min(-1)). Thin films of amorphous rhodium and rhodium phosphide (Rh2P) were grown from 1 and 3 at 170 and 130 degrees C respectively at 0.3 mmHg in a hot wall reactor using H-2 as the carrier gas (7 cc min(-1)).Welch Foundation F-816Petroleum Research Fund 47014-ACSNSF 0741973Chemistr

Visual preference for social stimuli in individuals with autism or neurodevelopmental disorders : an eye-tracking study

Background Recent research has identified differences in relative attention to competing social versus non-social video stimuli in individuals with autism spectrum disorder (ASD). Whether attentional allocation is influenced by the potential threat of stimuli has yet to be investigated. This is manipulated in the current study by the extent to which the stimuli are moving towards or moving past the viewer. Furthermore, little is known about whether such differences exist across other neurodevelopmental disorders. This study aims to determine if adolescents with ASD demonstrate differences in attentional allocation to competing pairs of social and non-social video stimuli, where the actor or object either moves towards or moves past the viewer, in comparison to individuals without ASD, and to determine if individuals with three genetic syndromes associated with differing social phenotypes demonstrate differences in attentional allocation to the same stimuli. Methods In study 1, adolescents with ASD and control participants were presented with social and non-social video stimuli in two formats (moving towards or moving past the viewer) whilst their eye movements were recorded. This paradigm was then employed with groups of individuals with fragile X, Cornelia de Lange, and Rubinstein-Taybi syndromes who were matched with one another on chronological age, global adaptive behaviour, and verbal adaptive behaviour (study 2). Results Adolescents with ASD demonstrated reduced looking-time to social versus non-social videos only when stimuli were moving towards them. Individuals in the three genetic syndrome groups showed similar looking-time but differences in fixation latency for social stimuli moving towards them. Across both studies, we observed within- and between-group differences in attention to social stimuli that were moving towards versus moving past the viewer. Conclusions Taken together, these results provide strong evidence to suggest differential visual attention to competing social versus non-social video stimuli in populations with clinically relevant, genetically mediated differences in socio-behavioural phenotypes

Leadership quality and follower affect - A study of U.S. presidential candidates: Working paper series--07-02

Using data from the seven most recent US presidential elections, two related analyses are conducted. The first presents an analysis of variance comparing Democratic and Republican Party candidates who were successful in securing votes to those who were unsuccessful in securing votes, using follower perceptions of candidate intelligence, candidate's degree of charisma, and follower feelings of positive and negative affect toward these candidates as the units for analysis. Here, perceived intelligence, feelings of pride and hope, as well as feelings of fear and anger, were found to be statistically different between the two groups. Specifically, candidates perceived to be higher in intelligence, who generated stronger feelings of pride and hope, and weaker feelings of fear and anger were more likely to receive voting support from their followers. The second analysis presents a regression model using follower assessments of candidates' leadership quality as dependent upon certain leader perceptual traits, including follower assessments of candidate intelligence and inspirational qualities, as well as follower affective responses (in terms of feelings of pride, hope, fear and anger) toward all candidates. Here, candidates perceived to be higher in intelligence, perceived to possess stronger degrees of inspirational quality, and who were judged more "likeable" in terms of generating stronger degrees of positive follower affect and lower degrees of negative follower affect are considered better quality leaders

Type Ibc supernovae in disturbed galaxies: evidence for a top-heavy IMF

We compare the radial locations of 178 core-collapse supernovae to the R-band and H alpha light distributions of their host galaxies. When the galaxies are split into `disturbed' and `undisturbed' categories, a striking difference emerges. The disturbed galaxies have a central excess of core-collapse supernovae, and this excess is almost completely dominated by supernovae of types Ib, Ic and Ib/c, whereas type II supernovae dominate in all other environments. The difference cannot easily be explained by metallicity or extinction effects, and thus we propose that this is direct evidence for a stellar initial mass function that is strongly weighted towards high mass stars, specifically in the central regions of disturbed galaxies.Comment: 22 pages, 5 figures, accepted for publication in Ap

Lunar Communication Terminals for NASA Exploration Missions: Needs, Operations Concepts and Architectures

NASA is conducting architecture studies prior to deploying a series of short- and long-duration human and robotic missions for the exploration of the Moon and Mars under the Vision for Space Exploration Initiative. A key objective of these missions is to establish and expand, through a series of launches, a system of systems approach to exploration capabilities and science return. The systems identified were Crew Exploration Vehicles, crew and cargo launch vehicles, crew EVA suits, crew and cargo landers, habitats, mobility carriers, and small, pressurized rovers. Multiple space communication networks and systems, deployed over time, will support these space exploration systems of systems. Each deployment phase will support interoperability of components and provide 20 years of legacy systems. In this paper, we describe the modular lunar communications terminals needed for the emerging lunar mission operational scenarios. These lunar communication terminals require flexibility for use in stationary, integrated, and mobile environments. They will support links directly to Earth, to lunar relay satellites, to astronauts and to fixed and mobile lunar surface systems. The operating concepts and traffic models are presented for these terminals within variety of lunar scenarios. A preliminary architecture is outlined, providing for suitable long-duration operations in the harsh lunar environment