Analysis of Opioid Prescription Patterns and Postoperative Opioid Use in Opioid-Naïve Patients Undergoing Elective Lumbar Spine Surgery

Title: Analysis of Opioid Prescription Patterns and Postoperative Opioid Use in Opioid-Naïve Patients Undergoing Elective Lumbar Spine Surgery Background: Post-operative opioid prescribing patterns after elective spine surgery is a growing topic of concern, as over-prescribing can lead to potential medication dependence, while under-prescribing can lead to inadequate pain management. Objective: The primary objective was to develop prescribing guidelines based upon the amount of opioids used in the first 2 weeks after lumbar spine surgery by 80% of patients. Methods: Utilizing a prospective study design, opioid-naïve patients undergoing elective lumbar spine surgery at our institution were identified each week and preoperatively consented for study participation. Opioid naivete was defined as lack of opioid use at least 1 month prior to the scheduled surgical procedure. At 2 weeks postoperatively, enrolled patients completed a telephone survey questionnaire, which assessed remaining opioid prescription pill count, need for medication refill, and subjective patient satisfaction with opioid dosing. Subsequently, patient charts were retrospectively reviewed for patient demographic and medical co-morbidity data. Univariate two group comparisons were performed using t-tests for continuous variables, and using chi-square, or Fisher’s tests if cell counts are \u3c5 for categorical variables. We then looked at the distribution of MMEs in each cohort in order to determine the opioid needs of 80% of the patient population. Results: A total of 53 opioid-naïve spine surgery patients were included for analysis, of which 23 underwent fusion surgery and 30 underwent non-fusion surgery. Baseline demographics and co-morbidities did not significantly vary between groups. For the fusion group, analysis revealed that an MME of 90 would meet the opioid requirements for 80% of patients. In this group, 60% of fusion patients were under-prescribed opioids, while 27% of patients were over-prescribed. For the non-fusion group, an MME of 45 was determined to meet the opioid requirements of 80% of patients. In this group, 61% of non-fusion patients were overprescribed opioids, while 22% were under prescribed. Conclusions: Amongst opioid-naïve patients who underwent elective lumber spine surgery, patients in the lumbar fusion group were generally under-prescribed postoperative opioids, while patients in the non-fusion groups were over-prescribed. This discrepancy suggests that spine surgeons must account for the procedure type (i.e., fusion vs non-fusion) when prescribing opiates postoperatively in opioid-naïve patients, given patients undergoing lumbar fusion may require a larger MME than non-fusion patients. Keywords: opioid-naïve; lumbar spine surgery; fusion; postoperative opioid use; MM

Aircraft Conceptual Design Using Vehicle Sketch Pad

Vehicle Sketch Pad (VSP) is a parametric geometry modeling tool that is intended for use in the conceptual design of aircraft. The intent of this software is to rapidly model aircraft configurations without expending the expertise and time that is typically required for modeling with traditional Computer Aided Design (CAD) packages. VSP accomplishes this by using parametrically defined components, such as a wing that is defined by span, area, sweep, taper ratio, thickness to cord, and so on. During this phase of frequent design builds, changes to the model can be rapidly visualized along with the internal volumetric layout. Using this geometry-based approach, parameters such as wetted areas and cord lengths can be easily extracted for rapid external performance analyses, such as a parasite drag buildup. At the completion of the conceptual design phase, VSP can export its geometry to higher fidelity tools. This geometry tool was developed by NASA and is freely available to U.S. companies and universities. It has become integral to conceptual design in the Aeronautics Systems Analysis Branch (ASAB) here at NASA Langley Research Center and is currently being used at over 100 universities, aerospace companies, and other government agencies. This paper focuses on the use of VSP in recent NASA conceptual design studies to facilitate geometry-centered design methodology. Such a process is shown to promote greater levels of creativity, more rapid assessment of critical design issues, and improved ability to quickly interact with higher order analyses. A number of VSP vehicle model examples are compared to CAD-based conceptual design, from a designer perspective; comparisons are also made of the time and expertise required to build the geometry representations as well

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

How Do Fruit Bat Seed Shadows Benefit Agroforestry? Insights from Local Perceptions in Kerala, India

Old-world fruit bats are known to provide significant benefits to tropical agroforestry through seed dispersal services. However, the social pathways through which local people perceive and actually utilize these benefits are not well understood. Through interview surveys with plantation owners and farmers in the Western Ghats of Kerala (India), we documented local perceptions and knowledge about the socio-ecological importance of fruit bat seed dispersal shadows. Respondents’ perceptions were highly positive, with greater benefits reported from seed dispersal, than costs from fruit damage by bats. Interestingly, seed aggregation of commercial fruit crops (cashew, areca) by fruit bats was perceived to reduce agricultural labour costs in plantations. Our study demonstrates that local perceptions can offer valuable insights toward understanding the contribution of bat-generated ecosystem services for tropical agroforestry systems, and in turn may facilitate effective fruit bat conservation

First record of a bat from the Lakshadweep archipelago, southwestern India

The first record of a bat species from the Lakshadweep archipelago (India) has been identified as Tadarida aegyptiaca (Chiroptera: Molossidae). It appears unlikely that any bat colony may have been resident on the islands. Stranding during migration, high aerial foraging, or disorientation by wind farms on the west coast of mainland India, are factors that need to be further explored to explain this occurrence

Water Leakage Detection System

The water deliver shortage has extended in latest years cutting-edge overpopulation, climate trade and obsolete water facilities, in which broken pipes purpose maximum brand new the water leaks. The trouble is present day leak as well as time it takes to discover. This paper affords the implementation latest a system hooked up inside the hydraulic facilities present day a residence, to come across water leaks. The machine consists of a water sensor mounted by a water reservoir cutting-edge hobby, a microprocessor to interpret the information and examine. The layout brand new a water flow leakage detector that may detect glide modern water in a certain water pipeline. there was wastage cutting-edge water every day through the pipeline leakages modern-day its full water had been by no means arrived to the faucets. The objectives cutting-edge our proposed paintings are to broaden a real-time prototype pipeline leakage alert system whether or not it's miles a water leak or no longer