Recommendations for the management of opioid-induced constipation - how to improve usability in clinical practice

INTRODUCTION: Opioid-induced constipation remains undertreated despite effective and safe treatment options exists. Previous guidelines have only been partially effective in improving management, possibly due to their complexity, and studies suggest that a simple setup of concise and behaviorally-orientated steps improves usability. AREAS COVERED: This article introduces the concept of opioid-induced constipation and provides an overview of existing guidelines in this field. We also propose simplified recommendations for managing opioid-induced constipation, derived from a synthesis of current guidelines and the principles of optimal guideline design theory. EXPERT OPINION: Despite standard treatment with laxatives and fluid intake in patients with opioid-induced constipation, escalation of treatment is often needed where μ-opioid receptor antagonists or newer medications such as lubiprostone, linaclotide, or prucalopride are used. Previous guidelines have not been used sufficiently and thus management of the condition is often insufficient. We therefore propose simplified recommendations to management, which we believe can come into broader use. It was validated in primary care for credibility, clarity, relevance, usability, and overall benefit. We believe that this initiative can lead to better management of the substantial proportion of patients suffering from side effects of opioids

Hydrologic and Water Quality Monitoring on Turkey Creek Watershed, Francis Marion National Forest, SC

2008 S.C. Water Resources Conference - Addressing Water Challenges Facing the State and Regio

Extended Formulations in Mixed-integer Convex Programming

We present a unifying framework for generating extended formulations for the polyhedral outer approximations used in algorithms for mixed-integer convex programming (MICP). Extended formulations lead to fewer iterations of outer approximation algorithms and generally faster solution times. First, we observe that all MICP instances from the MINLPLIB2 benchmark library are conic representable with standard symmetric and nonsymmetric cones. Conic reformulations are shown to be effective extended formulations themselves because they encode separability structure. For mixed-integer conic-representable problems, we provide the first outer approximation algorithm with finite-time convergence guarantees, opening a path for the use of conic solvers for continuous relaxations. We then connect the popular modeling framework of disciplined convex programming (DCP) to the existence of extended formulations independent of conic representability. We present evidence that our approach can yield significant gains in practice, with the solution of a number of open instances from the MINLPLIB2 benchmark library.Comment: To be presented at IPCO 201

Actinomyces associated with persistent vaginal granulation tissue.

BACKGROUND: We report a case of symptomatic actinomycosis associated with vaginal suture erosion and granulation tissue refractory to conservative management, in an outpatient setting. CASE: Three months after total vaginal hysterectomy and uterosacral ligament vaginal vault suspension, a woman complained of painless, intermittent vaginal discharge and spotting. Despite cauterization of granulation tissue, vaginal spotting persisted for another month. On re-examination, braided polyester suture that was found underlying the granulation tissue was removed. Recurrent symptoms, together with a biopsy revealing actinomycetes, prompted a trial of oral penicillin VK. With persistent symptoms and discomfort during attempts in the outpatient clinic, the woman eventually required suture removal in the operating room. Her symptoms subsequently resolved without recurrence, and no further antibiotic treatment was required. CONCLUSIONS: Actinomyces may be associated with persistent granulation tissue and vault suspension suture material. In rare circumstances, when tissue debridement and suture removal in the clinic is unsatisfactory, surgical intervention in the operating room may be necessary. Ten days of antibiotic therapy alone did not eradicate the granulation tissue, and symptoms resolved only after complete removal of the underlying permanent suture

Hard-Thermal-Loop Corrections in Leptogenesis II: Solving the Boltzmann Equations

We investigate hard-thermal-loop (HTL) corrections to the final lepton asymmetry in leptogenesis. To this end we solve the Boltzmann equations with HTL-corrected rates and CP asymmetries, which we calculated in paper I of this series. We pay special attention to the influence of the two leptonic quasiparticles that arise at non-zero temperature. We include only decays and inverse decays and allow for the lepton modes to be either decoupled from each other, or to be in chemical equilibrium by some strong interaction, simulating the interaction with gauge bosons. In two additional cases, we approximate the full HTL lepton propagators with zero-temperature propagators, where we replace the zero-temperature mass by the thermal mass of the leptons $m_\ell(T)$ or the asymptotic mass $\sqrt{2} \, m_\ell(T)$. We compare the final lepton asymmetries of the four thermal cases and the zero-temperature case for zero, thermal and dominant initial neutrino abundance. The final lepton asymmetries of the thermal cases differ considerably from the vacuum case and from each other in the weak washout regime for zero initial neutrino abundance and in the intermediate regime for dominant initial neutrino abundance. In the strong washout regime, the final lepton asymmetry can be enhanced by a factor of two in the case of strongly interacting lepton modes.Comment: 51 pages, 27 figure

Dynamics of oscillating scalar field in thermal environment

There often appear coherently oscillating scalar fields in particle physics motivated cosmological scenarios, which may have rich phenomenological consequences. Scalar fields should somehow interact with background thermal bath in order to decay into radiation at an appropriate epoch, but introducing some couplings to the scalar field makes the dynamics complicated. We investigate in detail the dynamics of a coherently oscillating scalar field, which has renormalizable couplings to another field interacting with thermal background. The scalar field dynamics and its resultant abundance are significantly modified by taking account of following effects : (1) thermal correction to the effective potential, (2) dissipation effect on the scalar field in thermal bath, (3) non-perturbative particle production events and (4) formation of non-topological solitons. There appear many time scales depending on the scalar mass, amplitude, couplings and the background temperature, which make the efficiencies of these effects non-trivial.Comment: 45 pages, 6 figures; v2: several typos corrected; v3: minor corrections and references added; v4: minor corrections to reflect the published version; v5: minor correction

Non-equlibrium effects in transport through quantum dots

The role of non-equilibrium effects in the conductance through quantum dots is investigated. Associated with single-electron tunneling are shake-up processes and the formation of excitonic-like resonances. They change qualitatively the low temperature properties of the system. We analyze by quantum Monte Carlo methods the renormalization of the effective capacitance and the gate-voltage dependent conductance. Experimental relevance is discussed.Comment: 10 pages, 8 postscript figure

Direct observation of incommensurate magnetism in Hubbard chains

The interplay between magnetism and doping is at the origin of exotic strongly correlated electronic phases and can lead to novel forms of magnetic ordering. One example is the emergence of incommensurate spin-density waves with a wave vector that does not match the reciprocal lattice. In one dimension this effect is a hallmark of Luttinger liquid theory, which also describes the low energy physics of the Hubbard model. Here we use a quantum simulator based on ultracold fermions in an optical lattice to directly observe such incommensurate spin correlations in doped and spin-imbalanced Hubbard chains using fully spin and density resolved quantum gas microscopy. Doping is found to induce a linear change of the spin-density wave vector in excellent agreement with Luttinger theory predictions. For non-zero polarization we observe a decrease of the wave vector with magnetization as expected from the Heisenberg model in a magnetic field. We trace the microscopic origin of these incommensurate correlations to holes, doublons and excess spins which act as delocalized domain walls for the antiferromagnetic order. Finally, when inducing interchain coupling we observe fundamentally different spin correlations around doublons indicating the formation of a magnetic polaron