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

Impairments in motor coordination without major changes in cerebellar plasticity in the Tc1 mouse model of Down syndrome

Down syndrome (DS) is a genetic disorder arising from the presence of a third copy of human chromosome 21 (Hsa21). Recently, O’Doherty et al. [An aneuploid mouse strain carrying human chromosome 21 with Down syndrome phenotypes. Science 309 (2005) 2033–2037] generated a trans-species aneuploid mouse line (Tc1) that carries an almost complete Hsa21. The Tc1 mouse is the most complete animal model for DS currently available. Tc1 mice show many features that relate to human DS, including alterations in memory, synaptic plasticity, cerebellar neuronal number, heart development and mandible size. Because motor deficits are one of the most frequently occurring features of DS, we have undertaken a detailed analysis of motor behaviour in cerebellum-dependent learning tasks that require high motor coordination and balance. In addition, basic electrophysiological properties of cerebellar circuitry and synaptic plasticity have been investigated. Our results reveal that, compared with controls, Tc1 mice exhibit a higher spontaneous locomotor activity, a reduced ability to habituate to their environments, a different gait and major deficits on several measures of motor coordination and balance in the rota rod and static rod tests. Moreover, cerebellar long-term depression is essentially normal in Tc1 mice, with only a slight difference in time course. Our observations provide further evidence that support the validity of the Tc1 mouse as a model for DS, which will help us to provide insights into the causal factors responsible for motor deficits observed in persons with DS

Hyperplastic and hypertrophic growth of lateral muscle in blackspot seabream Pagellus bogaraveo from hatching to juvenile

To understand better the growth mechanisms in the economically important fish Pagellus bogaraveo, in terms of muscle fibre hyperplasia v. hypertrophy, the lateral muscle of this fish was studied morphometrically from hatching to juvenile comparing rostral and caudal locations. Fish were sampled at 0, 5, 23, 40, 70, 100, 140 and 180 days. Fibre types were first identified by succinate dehydrogenase (SDH) and immunostaining with a polyclonal antibody against fish slow myosin (4-96). Morphometric variables were then measured in transverse body sections, at both post-opercular and post-anal locations, to estimate the following variables: total muscle area [A (muscle)], total fibre number [N (fibres)], fibre number per unit area of muscle [N-A (fibres, muscle)] and cross-sectional fibre area [a (fibres)] of the two main muscle fibre types (white and red). Overall, growth throughout the various stages resulted from increases both in the number and in the size of muscle fibres, paralleled by an expansion of the [A (muscle)]. Nonetheless, that increase was not significant between 0-5 days on one hand and 100-140 days, on the other hand. On the contrary, the [N-A (fibres, muscle)] declined as the body length increased. Analysis of the muscle growth kinetics suggested that, within the important time frame studied, hyperplasia gave the main relative contribution to the increase of white muscle [A (white muscle)], whereas red muscle [A (red muscle)] mainly grew by hypertrophy, with both phenomena occurring at a faster pace posteriorly in the body. Finally, when comparing rostral and caudal locations, a greater [N (fibres)] and [A (muscle)] of the posterior white and red fibres were the consistent features. It was also observed that the proportion of the cross-sectional area of the myotomal muscle comprised of white muscle was greater in the anterior part of the fish

Deformed Special Relativity as an effective theory of measurements on quantum gravitational backgrounds

In this article we elaborate on a recently proposed interpretation of DSR as an effective measurement theory in the presence of non-negligible (albeit small) quantum gravitational fluctuations. We provide several heuristic arguments to explain how such a new theory can emerge and discuss the possible observational consequences of this framework.Comment: 11 pages, no figure

Double-Tuned Birdcage Radio Frequency Coil for 7 T MRI: Optimization, Construction and Workbench Validation

The aim of the present study is the optimization, construction, and workbench validation of a double-tuned 1H- 23Na volume radio frequency (RF) coil suitable for human head imaging at 7 T, based on the birdcage geometry. The birdcage-like design which is considered is the four-ring model, in which two standard birdcage-like structures with the same diameters are nested along the longitudinal axis. Simulations based on Maxwell’s equations are performed to evaluate the RF magnetic field homogeneity and the RF coil efficiency varying the coil geometrical parameters. The RF magnetic field homogeneity is evaluated both on the transverse (z = 0) and longitudinal (y = 0) planes without performing the impedance matching procedure, so that the RF coil symmetry is not perturbed by the matching network. The RF coil efficiency is instead dependent on the effective coil input RF power, and it is evaluated after matching the coil, so that the reflected power is minimized, assuming that the stimulation power is totally delivered to the RF coil. Considering the simulation results and the target application, the useful RF coil geometrical parameters are fixed. The four-ring model, which showed the best performances, has been built and tested on a workbench, using a cylindrical phantom filled with a 0.05 M saline solution as load. This provides the first example of a four-ring realization intended 1H- 23Na for human head imaging at 7 T

Theta dependence of CP^9 model

We apply to the $CP^9$ model two recently proposed numerical techniques for simulation of systems with a theta term. The algorithms, successfully tested in the strong coupling limit, are applied to the weak coupling region. The results agree and errors have been evaluated and are at % level. The results scale well with the renormalization group equation and show that, for $CP^9$ in presence of a theta term, CP symmetry is spontaneously broken at $\theta=\pi$ in the continuum limit.Comment: 4 pages, 4 figure