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

Two-Photon Absorption Laser Induced Fluorescence Measurements of Neutral Density in Helicon Plasma

Neutral particles play a critical role in plasma experiments. They simultaneously act as a source of particles and a sink of momentum and energy. Also, they act as an intermediary between the plasma and surrounding material walls. However, few methods exist to make localized, direct neutral density measurements. A new diagnostic, based on two-photon absorption laser induced fluorescence (TALIF), capable of making direct ground state measurement is developed. A high intensity (5 MW/cm2), narrow bandwidth (0.1 cm -1) laser is used to directly probe the ground state of neutral hydrogen, deuterium and krypton. The diagnostic represents an improvement over traditional laser induced fluorescence in that it can be used to measure the spatial profile from a single porthole, and it can be operated in a Doppler-free configuration. The system is tested and calibrated in a low temperature helicon plasma source. Calculations show the system has sufficient performance to achieve an acceptable signal-to-noise ratio in a high temperature fusion plasma. Development of the diagnostic is presented in this work along with both steady-state and time-resolved TALIF measurements in helicon plasma

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

Requirements for sulfate transport and the diastrophic dysplasia sulfate transporter in fibronectin matrix assembly

Diastrophic dysplasia sulfate transporter (DTDST) is a sulfate/chloride antiporter whose function is impaired in several human chondrodysplasias. We show that DTDST is upregulated by dexamethasone stimulation of HT1080 fibrosarcoma cells and is required for fibronectin (FN) extracellular matrix deposition by these cells. DTDST imports sulfate for the modification of glycosaminoglycans. We find that N-sulfation of these chains is important for FN matrix assembly and that sulfation of cell surface proteoglycans is reduced in the absence of DTDST. Of the candidate HT1080 cell surface proteoglycans, only loss of syndecan-2 compromises FN assembly, as shown by syndecan-2 small interfering RNA knockdown. DTDST is both necessary and sufficient to induce FN matrix assembly in HT1080 cells. Knockdown of DTDST ablates FN matrix, whereas its overexpression increases assembly without dexamethasone stimulation. These results identify a previously unrecognized regulatory pathway for matrix assembly via modulation of a sulfate transporter and proteoglycan sulfation. These data raise the possibility that FN assembly defects contribute to chondrodysplasias

Approaching Space Time Through Velocity in Doubly Special Relativity

We discuss the definition of velocity as dE/dp, where E,p are the energy and momentum of a particle, in Doubly Special Relativity (DSR). If this definition matches dx/dt appropriate for the space-time sector, then space-time can in principle be built consistently with the existence of an invariant length scale. We show that, within different possible velocity definitions, a space-time compatible with momentum-space DSR principles can not be derived.Comment: 11 pages, no figures, minor changes, references added, final version to appear in PR

A multi-objective approach to solid waste management

The issue addressed in this paper consists in the localization and dimensioning of transfer stations, which constitute a necessary intermediate level in the logistic chain of the solid waste stream, from municipalities to the incinerator. Contextually, the determination of the number and type of vehicles involved is carried out in an integrated optimization approach. The model considers both initial investment and operative costs related to transportation and transfer stations. Two conflicting objectives are evaluated, the minimization of total cost and the minimization of environmental impact, measured by pollution. The design of the integrated waste management system is hence approached in a multi-objective optimization framework. To determine the best means of compromise, goal programming, weighted sum and fuzzy multi-objective techniques have been employed. The proposed analysis highlights how different attitudes of the decision maker towards the logic and structure of the problem result in the employment of different methodologies and the obtaining of different results. The novel aspect of the paper lies in the proposal of an effective decision support system for operative waste management, rather than a further contribution to the transportation problem. The model was applied to the waste management of optimal territorial ambit (OTA) of Palermo (Italy)