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

Prospective observational study of point-of-care creatinine in trauma.

Background:Patients with trauma are at risk for renal dysfunction from hypovolemia or urological injury. In austere environments, creatinine values are not available to guide resuscitation. A new portable device, the Stat Sensor Point-of-care (POC) Whole Blood Creatinine Analyzer, provides accurate results in <30 s and requires minimal training. This device has not been evaluated in trauma despite the theoretical benefit it provides. The purpose of this study is to determine the clinical impact of the POC device in trauma. Methods:40 patients with trauma were enrolled in a prospective observational study. One drop of blood was used for creatinine determination on the Statsensor POC device. POC creatinine results were compared to the laboratory. Turnaround time (TAT) for POC and laboratory methods was calculated as well as time elapsed to CT scan if applicable. Results:Patients (n=40) were enrolled between December 2014 and March 2015. POC creatinine values were similar to laboratory methods with a mean bias of 0.075±0.27 (p=0.08). Mean analytical TATs for the POC measurements were significantly faster than the laboratory method (11.6±10.0 min vs 78.1±27.9 min, n=40, p<0.0001). Mean elapsed time before arrival at the CT scanner was 52.9±34.2 min. Conclusions:The POC device reported similar creatinine values to the laboratory and provided significantly faster results. POC creatinine testing is a promising development for trauma practice in austere environments and workup of a subset of stable patients with trauma. Further study is warranted to determine clinical impact, both in hospital-based trauma and austere environments

Importance of activity data for improving the residential wood combustion emission inventory at regional level

The contribution of residential wood combustion (RWC) to emission inventory at local level was estimated using a bottomeup approach for the Lombardy Region of North Italy. A survey, based on the CATI (Computer Assisted Telephone Interviewing) method, has been undertaken through 18,000 interviews. The interviews had the objective to characterize the RWC use in this region, in term of both total and municipal wood consumption. Details on the type of appliances used in RWC were also gathered. The results of the survey were then statistically analyzed in order to allow an estimate of RWC with high spatial resolution (i.e., at municipal level) in relation to the size and altitude of the territory. The work provides new evidence of the importance of wood combustion as a key source for PM and NMVOC emissions at local level, and thus highlights the importance of technological improvements and new policies aimed at emission reduction in this sector. Considering the great differences in average PM emission factors between low efficiency appliances (fireplaces, old stoves) and high efficiency ones (new stoves, pellet burners), this work emphasizes the importance of obtaining more detailed information on the types of wood appliances used for arriving at a reliable PM emission inventory for RWC

Gamma-ray burst observations with new generation imaging atmospheric Cerenkov Telescopes in the FERMI era

After the launch and successful beginning of operations of the FERMI satellite, the topics related to high-energy observations of gamma-ray bursts have obtained a considerable attention by the scientific community. Undoubtedly, the diagnostic power of high-energy observations in constraining the emission processes and the physical conditions of gamma-ray burst is relevant. We briefly discuss how gamma-ray burst observations with ground-based imaging array Cerenkov telescopes, in the GeV-TeV range, can compete and cooperate with FERMI observations, in the MeV-GeV range, to allow researchers to obtain a more detailed and complete picture of the prompt and afterglow phases of gamma-ray bursts.Comment: 9 pages, two figures. Proceeding for the 6th "Science with the New Generation of High Energy Gamma-Ray Experiments" worksho

Benzo(a)pyrene air concentrations and emission inventory in Lombardy region, Italy

Three years of particle phase B(a)P air concentration measurements in 13 sites in Lombardy (Italy) and a detailed emission inventory at the municipal scale for the whole region were used to infer the contribution of different sources to B(a)P atmospheric levels. The analyses of the weekly and monthly profiles of B(a)P concentrations, the cluster analysis and the comparison between the B(a)P/PM10 ratios in ambient air and in the emissions allowed identifying wood burning in small residential appliances as the key source for all the sites, except for those located in Milan. The highest values of the average B(a)P concentrations were not found in the wider urban areas, where in general the highest PM10 levels were registered. Regarding the seasonal variability, a marked reduction of both B(a)P concentrations and B(a)P/PM10 ratios was observed in the summer season. The cluster analysis of PM10 and B(a)P concentrations showed that the two pollutants tend to have a separate pattern; moreover the cluster analysis of B(a)P/PM10 ratios showed that the trend of this ratio split the stations depending on their location: plain area, piedmont and valley zones, and mountain sites. The dominance of the wood combustion highlighted by the emission inventory, originating from the residential sector and from pizzerias in the city of Milan, is consistent with the findings of other studies based on a source apportionment approach or air quality modeling, although some patterns of ambient B(a)P concentrations in one site were not adequately explained by the emission sources included in the emission inventory

Fattori di emissione dalla combustione di legna e pellet in piccoli apparecchi domestici

The aim of this study was to report emission factors of pollutants (i.e., carbon monoxide, nitrogen oxides, non-methane hydrocarbons, particulate matter, polycyclic aromatic hydrocarbons, dioxins) from biomass burning residential heating appliances. The influence of several factors such as biomass type, appliance and combustion cycle was investigated. Four manually fed (6-11 kW) firewood burning and two automatic wood pellets (8.8-25 kW) appliances were tested under real-world operating conditions in order to determine the actual environmental performance of the appliance. The experimental EFs were also compared with the values proposed by the European emission inventory guidebook used in the local inventory in order to evaluate their representativeness of real world emissions. The composite macropollutant EFs for manually fed appliances are: for CO 5858 g GJ-1, for NOx 122 g GJ-1, NMHC 542 g GJ-1, PM 254 g GJ-1, whereas emissions are much lower for automatic pellets appliances: CO 219 g GJ-1, for NOx 66 g GJ-1, NMHC 5 g GJ-1, PM 85 g GJ-1. The open fireplace appears to have very high emission factors, however traditional and advanced stoves show the highest overall CO EFs. Especially for the advanced stove real-world emissions are far worse than those measured under cycles used for type testing of residential solid fuel appliances. No great difference is observed for different firewood types in batch working appliances, diversely the quality of the pellets is observed to influence directly the emission performance of the automatic appliances. Benzo(b)fluoranthene is the PAH with the highest contribution (110 mg GJ-1 for manual appliances and 2 mg GJ-1 for automatic devices) followed by benzo(a)pyrene (77 mg GJ-1 for manual appliances and 0,8 mg GJ-1 for automatic devices)

Modified Special Relativity on a fluctuating spacetime

It was recently proposed that deformations of the relativistic symmetry, as those considered in Deformed Special Relativity (DSR), can be seen as the outcome of a measurement theory in the presence of non-negligible (albeit small) quantum gravitational fluctuations [1,2]. In this paper we explicitly consider the case of a spacetime described by a flat metric endowed with stochastic fluctuations and, for a free particle, we show that DSR-like nonlinear relations between the spaces of the measured and classical momenta, can result from the average of the stochastic fluctuations over a scale set be the de Broglie wavelength of the particle. As illustrative examples we consider explicitly the averaging procedure for some simple stochastic processes and discuss the physical implications of our results.Comment: 7 pages, no figure

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