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

Psychosocial Predictors of Metabolic Syndrome among Latino Groups in the Multi-Ethnic Study of Atherosclerosis (MESA).

ObjectiveWe sought to determine the contribution of psychological variables to risk for metabolic syndrome (MetS) among Latinos enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA), and to investigate whether social support moderates these associations, and whether inflammatory markers mediate the association between psychological variables and MetS.Research design and methodsCross-sectional analyses at study baseline were conducted with a national Latino cohort (n = 1,388) that included Mexican Americans, Dominican Americans, Puerto Rican Americans and Central/South Americans. Hierarchical logistic regression analyses were conducted to test the effects of psychosocial variables (chronic stress, depressive symptoms, and social support) on MetS. In addition, separate subgroup-specific models, controlling for nationality, age, gender, socioeconomic position, language spoken at home, exercise, smoking and drinking status, and testing for the effects of chronic stress, depressive symptoms and inflammation (IL-6, CRP, fibrinogen) in predicting risk for MetS were conducted.ResultsIn the overall sample, high chronic stress independently predicted risk for MetS, however this association was found to be significant only in Mexican Americans and Puerto Rican Americans. Social support did not moderate the associations between chronic stress and MetS for any group. Chronic stress was not associated with inflammatory markers in either the overall sample or in each group.ConclusionsOur results suggest a differential contribution of chronic stress to the prevalence of MetS by national groups

Review of "Conducting Educational Research: A primer for teachers and administrators"

Book Title: Conducting Educational Research: A primer for teachers and administrators Book Authors: Morrell, P.D. and Carroll, J.B. Publisher: Sense Publishers Reviewers: Steve Keirl (Goldsmiths, University of London) and Christine Edwards-Leis (St Mary's University College) ISBN: 978-94-6091-202-3 (paperback) ISBN: 978-94-6091-204-7 (e-book

You measure what you value: how a Middle Eastern Polytechnic developed a sustainable review and improvement framework

Bahrain Polytechnic (BP) was established in 2008 to fill a gap in the Kingdom’s labour market for work ready graduates. Around that time newspaper reports highlighted a lack of quality and consistency in some private universities in Bahrain. Bahrain’s Qualifications and Quality Assurance Authority was in development so, in the absence of national guidelines, BP developed its own Quality Assurance Model to gain stakeholder confidence in the quality of its education. This comprised a Quality Management System with policies and procedures, and a self-review loop. The government was quick to redress quality concerns threatening the reputation of Higher Education in the Kingdom and today there are many external auditing agencies, each with their own paradigms and criteria. However, evidence that accountability audits produce quality improvement where it matters most - in the classroom - is lacking. An essential element in this failure is the dissolution of trust. This case-study tells of BP’s journey towards a more efficient and effective Self-Review model that shifts the focus from accountability and control to improvement and sustainability by taking into account Bahrain’s cultural context and the Polytechnic’s unique curricula and building on existing relationships to engender trust and commitment

Archeota, Fall 2019

This is the Fall 2019 issue of Archeota, the official publication of SJSU SAASC. Archeota is a platform for students to contribute to the archival conversation. It is written BY students, FOR students. It provides substantive content on archival concerns and issues, and promotes career development in the field of archival studies. Archeota upholds the core values of the archival profession. It is a semiannual publication of the Student Chapter of the Society of American Archivists at the San Jose State University School of Information.https://scholarworks.sjsu.edu/saasc_archeota/1010/thumbnail.jp

Effects of Friction on the Dynamic Behavior of Flexible Rocking Bodies

Flexible rocking bodies are freestanding structures that are free to deform and rock, potentially overturning, when subject to ground excitation. Prior research on the seismic behavior of this type of structure typically assumed sufficient friction at the ground surface to avoid sliding motion. However, experimental observations showed that this assumption was often violated and structures demonstrated non-negligible sliding during their responses. The overarching goal of this study is to evaluate the impact of sliding on the overturning response of flexible rocking bodies. To this end, a two-dimensional analytical model was developed in a Lagrangian formulation, which is presented in this paper. This model was subjected to one-cycle sine pulses of varying amplitude and frequency for several levels of base friction to quantify the impact of sliding on overturning. In general, the results highlight that sliding behavior reduces the overturning demand, however motion-to-motion variability was observed

Chandra Observations of NGC 4438: An Environmentally Damaged Galaxy in the Virgo Cluster

We present results from a 25 ksec CHANDRA ACIS-S observation of galaxies NGC4438 and NGC4435 in the Virgo Cluster. X-ray emission in NGC4438 is observed in a ~700 pc nuclear region, a 2.3 kpc spherical bulge, and a network of filaments extending 4-10 kpc to the W and SW of the galaxy. The X-ray emission in all 3 regions is highly correlated to similar features observed in Halpha. Spectra of the filaments and bulge are well represented by a 0.4 keV MEKAL model with combined 0.3-2 keV intrinsic luminosity of 1.24x10^{40}erg/s, electron densities ~ 0.02-0.04 cm^{-3}, cooling times of 400-700 Myr and X-ray gas mass <~ 3.7x10^8 Msolar. In the nuclear region of NGC4438 X-ray emission is seen from the nucleus and from two outflow bubbles extending 360(730) pc to the NW(SE) of the nucleus. The spectrum of the NW outflow bubble plus nucleus is well fitted by an absorbed (n_H=1.9x10^{21} cm^{-2}) 0.58 keV MEKAL plasma model plus a heavily absorbed (n_H = 2.9 x10^{22} cm^{-2}) Gamma = 2, power law component. The electron density, cooling time, and X-ray gas mass in the NW outflow are ~0.5 cm^{-3}, 30 Myr and 3.5x10^6 Msolar. Weak X-ray emission is observed in the central region of NGC4435 with the peak of the hard emission coincident with the galaxy's optical center; while the peak of the soft X-ray emission is displaced 316 pc to the NE. The spectrum of NGC 4435 is well fitted by a non-thermal power law plus a thermal component from 0.2-0.3 keV diffuse ISM gas. We argue that the X-ray properties of gas outside the nuclear region in NGC4438 and in NGC4435 favor a high velocity, off-center collision between these galaxies ~ 100 Myr ago; while the nuclear X-ray emitting outflow gas in NGC4438 has been heated only recently (within ~ 1-2 Myr) by shocks (v_s ~ 600 kms^{-1}) possibly powered by a central AGN.Comment: 40 pages, 7 figures; minor changes to conform to published version, improved spectral fits to NGC 4435, improved figures 3,5; new figures 6b,

Multivoxel Patterns in Face-Sensitive Temporal Regions Reveal an Encoding Schema Based on Detecting Life in a Face

More than a decade of research has demonstrated that faces evoke prioritized processing in a ‘core face network’ of three brain regions. However, whether these regions prioritize the detection of global facial form (shared by humans and mannequins) or the detection of life in a face has remained unclear. Here, we dissociate form-based and animacy-based encoding of faces by using animate and inanimate faces with human form (humans, mannequins) and dog form (real dogs, toy dogs). We used multivariate pattern analysis of BOLD responses to uncover the representational similarity space for each area in the core face network. Here, we show that only responses in the inferior occipital gyrus are organized by global facial form alone (human vs dog) while animacy becomes an additional organizational priority in later face-processing regions: the lateral fusiform gyri (latFG) and right superior temporal sulcus. Additionally, patterns evoked by human faces were maximally distinct from all other face categories in the latFG and parts of the extended face perception system. These results suggest that once a face configuration is perceived, faces are further scrutinized for whether the face is alive and worthy of social cognitive resources