Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy for Prescribing Recommendations and Community Safety.

Background: Orthopaedic surgeons are confronted with a difficult dilemma: managing acute pain postoperatively and balancing the risk of prescription opioid use. To our knowledge, a prospective performance-improvement project providing opioid-prescription recommendations based on the actual amounts of usual and customary medication consumed following simple knee meniscectomy has not been described. Methods: One hundred and two patients undergoing arthroscopic knee meniscectomy prospectively recorded postoperative pain medications in a pain journal. Arthroscopic procedures were performed at 2 centers by 9 fellowship-trained senior surgeons. Various usual and customary prescribing protocols were observed, and the amount of medication consumed was recorded. Prescription and over-the-counter pain medication, quantity, frequency, and visual analog scale (VAS) pain scores were collected. Results: One hundred and two patients filled a prescription opioid medication and were included in the study. A total of 3,765 pills were prescribed, and a total of 573.5 were consumed. For the 102 patients who filled a prescription, the average time consuming opioid medication was 2 ± 2 days (range, 0 to 13 days) postoperatively. No cases of persistent use were recorded. Of the 102 patients who filled a prescription, 29.4% did not take any prescription opioids postoperatively. A total of 3,191.5 pills (or 22,183.75 morphine milligram equivalents [MME]) were unused and were potentially available to the community. Conclusions: Following simple knee arthroscopy, the amount of prescribed opioid medication exceeds the need for postoperative pain management. In general, 68% of patients require a maximum of 13 pills postoperatively for 6 days. Surgeons should adjust prescribing standards accordingly to limit the amount of prescription opioids available to the community. Furthermore, a comprehensive response to include increased patient screening and monitoring as well as opioid use and disposal education is recommended

SRRM2, a Potential Blood Biomarker Revealing High Alternative Splicing in Parkinson's Disease

Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects about five million people worldwide. Diagnosis remains clinical, based on phenotypic patterns. The discovery of laboratory markers that will enhance diagnostic accuracy, allow pre-clinical detection and tracking of disease progression is critically needed. These biomarkers may include transcripts with different isoforms.We performed extensive analysis on 3 PD microarray experiments available through GEO and found that the RNA splicing gene SRRM2 (or SRm300), sereine/arginine repetitive matrix 2, was the only gene differentially upregulated among all the three PD experiments. SRRM2 expression was not changed in the blood of other neurological diseased patients versus the healthy controls. Using real-time PCR, we report that the shorter transcript of SRRM2 was 1.7 fold (p = 0.008) upregulated in the substantia nigra of PDs vs controls while the longer transcript was 0.4 downregulated in both the substantia nigra (p = 0.03) and amygdala (p = 0.003). To validate our results and test for the possibility of alternative splicing in PD, we performed independent microarray scans, using Affymetrix Exon_ST1 arrays, from peripheral blood of 28 individuals (17 PDs and 11 Ctrls) and found a significant upregulation of the upstream (5') exons of SRRM2 and a downregulation of the downstream exons, causing a total of 0.7 fold down regulation (p = 0.04) of the long isoform. In addition, we report novel information about hundreds of genes with significant alternative splicing (differential exonic expression) in PD blood versus controls.The consistent dysregulation of the RNA splicing factor SRRM2 in two different PD neuronal sources and in PD blood but not in blood of other neurologically diseased patients makes SRRM2 a strong candidate gene for PD and draws attention to the role of RNA splicing in the disease

Searching for an Enhanced Signal of the Onset of Color Transparency in Baryons with D(e,e′p)n Scattering

Observation of the onset of color transparency in baryons would provide a new means of studying the nuclear strong force and would be the first clear evidence of baryons transforming into a color-neutral point-like size in the nucleus as predicted by quantum chromodynamics. Recent C (e, e′p) results from electron-scattering did not observe the onset of color transparency (CT) in protons up to spacelike four-momentum transfers squared, Q2 = 14.2 GeV 2 . The traditional methods of searching for CT in (e, e′p) scattering use heavy targets favoring kinematics with already initially reduced final state interactions (FSIs) such that any CT effect that further reduces FSIs will be small. The reasoning behind this choice is the difficulty in accounting for all FSIs. D (e, e′p)η , on the other hand, has well-understood FSI contributions from double scattering with a known dependence on the kinematics and can show an increased sensitivity to hadrons in point-like configurations. Double scattering is the square of the re-scattering amplitude in which the knocked-out nucleon interacts with the spectator nucleon, a process that is suppressed in the presence of point-like configurations and is particularly well-studied for the deuteron. This suppression yields a quadratic sensitivity to CT effects and is strongly dependent on the choice of kinematics. Here, we describe a possible Jefferson National Accelerator Facility (JLab) electron-scattering experiment that utilizes these kinematics and explores the potential signal for the onset of CT with enhanced sensitivity as compared to recent experiments

On the Fluctuation Relation for Nose-Hoover Boundary Thermostated Systems

We discuss the transient and steady state fluctuation relation for a mechanical system in contact with two deterministic thermostats at different temperatures. The system is a modified Lorentz gas in which the fixed scatterers exchange energy with the gas of particles, and the thermostats are modelled by two Nos\'e-Hoover thermostats applied at the boundaries of the system. The transient fluctuation relation, which holds only for a precise choice of the initial ensemble, is verified at all times, as expected. Times longer than the mesoscopic scale, needed for local equilibrium to be settled, are required if a different initial ensemble is considered. This shows how the transient fluctuation relation asymptotically leads to the steady state relation when, as explicitly checked in our systems, the condition found in [D.J. Searles, {\em et al.}, J. Stat. Phys. 128, 1337 (2007)], for the validity of the steady state fluctuation relation, is verified. For the steady state fluctuations of the phase space contraction rate \zL and of the dissipation function \zW, a similar relaxation regime at shorter averaging times is found. The quantity \zW satisfies with good accuracy the fluctuation relation for times larger than the mesoscopic time scale; the quantity \zL appears to begin a monotonic convergence after such times. This is consistent with the fact that \zW and \zL differ by a total time derivative, and that the tails of the probability distribution function of \zL are Gaussian.Comment: Major revision. Fig.10 was added. Version to appear in Journal of Statistical Physic

PROPHETIC EU: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit in European and United States Cohorts

Background The prospective identification of patients at high risk for hospital-acquired/ventilator-associated bacterial pneumonia may improve clinical trial feasibility and foster antibacterial development. In a prior study conducted in the United States, clinical criteria were used to prospectively identify these patients; however, these criteria have not been applied in a European population. Methods Adults considered high risk for pneumonia (treatment with ventilation or high levels of supplemental oxygen) in the intensive care units of 7 European hospitals were prospectively enrolled from June 12 to December 27, 2017. We estimated the proportion of high-risk patients developing pneumonia according to US Food and Drug Administration guidance and a subset potentially eligible for antibacterial trial enrollment. We compared patient characteristics, treatment exposures, and pneumonia incidence in a European cohort and a previously described US cohort. Results Of 888 high-risk patients, 211/888 (24%) were treated for possible pneumonia, and 150/888 (17%) met the Food and Drug Administration definition for hospital-acquired/ventilator-associated bacterial pneumonia. A higher proportion of European patients treated for possible pneumonia met the pneumonia definition (150/211 [71%] vs 537/1464 [37%]; P < .001). Among patients developing pneumonia, a higher proportion of European patients met antibacterial trial eligibility criteria (124/150 [83%] vs 371/537 [69%]; P < .001). Conclusions Clinical criteria prospectively identified high-risk patients with high rates of pneumonia in the European cohort. Despite higher rates of established risk factors and incident pneumonia, European patients were significantly less likely to receive antibiotics for possible pneumonia than US patients. Different treatment practices may contribute to lower rates of antibacterial trial enrollment in the United States

A Soil Management Assessment Framework (SMAF) Evaluation of Brazilian Sugarcane Expansion on Soil Quality

The Soil Management Assessment Framework (SMAF) was developed to evaluate impacts of land use and management practices on soil quality (SQ), but its suitability for Brazilian tropical soils was unknown. We hypothesized that SMAF would be sensitive enough to detect SQ changes associated with sugarcane (Saccharum officinarum L.) expansion for ethanol production. Field studies were performed at three sites across the south-central region of Brazil, aiming to quantify the impacts of a land use change sequence (i.e., native vegetation–pasture–sugarcane) on SQ. Eight soil indicators were individually scored using SMAF curves developed primarily for North American soils and integrated into an overall Soil Quality Index (SQI) and its chemical, physical, and biological sectors. The SMAF scores were correlated with two other approaches used to assess SQ changes, soil organic C (SOC) stocks and Visual Evaluation of Soil Structure (VESS) scores. Our findings showed that the SMAF was an efficient tool for assessing land use change effects on the SQ of Brazilian tropical soils. The SMAF scoring curves developed using robust algorithms allowed proper assignment of scores for the soil chemical, physical, and biological indicators assessed. The SQI scores were significantly correlated with SOC stocks and VESS scores. Long-term transition from native vegetation to extensive pasture promoted significant decreases in soil chemical, physical, and biological indicators. Overall SQI suggested that soils under native vegetation were functioning at 87% of their potential capacity, while pasture soils were functioning at 70%. Conversions of pasture to sugarcane induced slight improvements in SQ, primarily because of improved soil fertility. Sugarcane soils are functioning at 74% of their potential capacity. Based on this study, management strategies were developed to improve SQ and the sustainability of sugarcane production in Brazil

Human Whole-Exome Genotype Data For alzheimer\u27s Disease

The heterogeneity of the whole-exome sequencing (WES) data generation methods present a challenge to a joint analysis. Here we present a bioinformatics strategy for joint-calling 20,504 WES samples collected across nine studies and sequenced using ten capture kits in fourteen sequencing centers in the Alzheimer\u27s Disease Sequencing Project. The joint-genotype called variant-called format (VCF) file contains only positions within the union of capture kits. The VCF was then processed specifically to account for the batch effects arising from the use of different capture kits from different studies. We identified 8.2 million autosomal variants. 96.82% of the variants are high-quality, and are located in 28,579 Ensembl transcripts. 41% of the variants are intronic and 1.8% of the variants are with CADD \u3e 30, indicating they are of high predicted pathogenicity. Here we show our new strategy can generate high-quality data from processing these diversely generated WES samples. The improved ability to combine data sequenced in different batches benefits the whole genomics research community

The study of vancomycin use and its adverse reactions associated to patients of a brazilian university hospital

<p>Abstract</p> <p>Background</p> <p>Vancomycin is an antibiotic of growing importance in the treatment of hospital infections, with particular emphasis on its value in the fight against methicillin-resistant <it>Staphylococcus aureus</it>. However its usage profile must be evaluated to assure maximum benefit and minimum risk.</p> <p>Findings</p> <p>A cross-sectional retrospective study was carried out among inpatients that received vancomycin in a Brazilian quaternary hospital. The occurrence of adverse reactions reported was evaluated in medical records relating to patients taking vancomycin during a one year period. Males comprised 52% (95% CI: 41.7-60.2%) of the sample population, with a mean age of 50.6 (95% CI: 47.2-54.0) years and mean treatment period of 9.7 (95% CI: 8.0-11.5) Days. It was verified that nephrotoxicity occurred in 18.4% (95% CI: 11.3-27.5) of patients, Red man syndrome occurred in 2% (95% CI 0.2-7.2), while the occurrence of thrombocytopenia was 7.1% (95% CI: 2.9-14.2).</p> <p>Conclusions</p> <p>It may be noted that even after 50 years of use, adverse reactions associated with vancomycin continue with high frequency, presenting a public health problem, especially considering its current use in cases of multidrug resistant infections. In this context, we emphasize the importance of intensive pharmacovigilance in hospital as a surveillance tool after drug approval by the sanitary authority.</p

Ice core chemistry database: an Antarctic compilation of sodium and sulfate records spanning the past 2000 years

Changes in sea ice conditions and atmospheric circulation over the Southern Ocean play an important role in modulating Antarctic climate. However, observations of both sea ice and wind conditions are limited in Antarctica and the Southern Ocean, both temporally and spatially, prior to the satellite era (1970 onwards). Ice core chemistry data can be used to reconstruct changes over annual, decadal, and millennial timescales. To facilitate sea ice and wind reconstructions, the CLIVASH2k (CLimate Variability in Antarctica and the Southern Hemisphere over the past 2000 years) working group has compiled a database of two species, sodium [Na+] and sulfate [SO2− 4 ], commonly measured ionic species. The database (https://doi.org/10.5285/9E0ED16E-F2AB4372-8DF3-FDE7E388C9A7; Thomas et al., 2022) comprises records from 105 Antarctic ice cores, containing records with a maximum age duration of 2000 years. An initial filter has been applied, based on evaluation against sea ice concentration, geopotential height (500 hPa), and surface wind fields to identify sites suitable for reconstructing past sea ice conditions, wind strength, or atmospheric circulation