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

Attracting FDI: Australian Government investment promotion in Japan, 1983-96

The trading relationship between Australia and Japan has been traditionally based on commodity exports, and a key Australian policy goal in the past has been to encourage Japanese investment in this sector in the hope of stabilising commodity trade. A serious deterioration in Australia’s terms of trade from the beginning of the 1980s resulting from a number of events – the global recession, the restructuring of Japanese industry and changes in Japan’s relations with the United States and the European Community – showed the need to diversify exports to Japan away from a heavy reliance on commodities and raw materials towards higher value-added primary products, manufactures and services. The attraction of Japanese investment into these sectors was an important part of this strategy. Japanese manufacturing investment was distinctly lacking in the mid-1980s and the Hawke and Keating governments used various methods to inform Japanese business of investment opportunities, provided tax incentives and research and development support for transnational corporations, and created the Investment Promotion Section (IPS) within the Tokyo office of Austrade to help promote investment. This paper shows how the IPS, which was established in 1991 to attract Japanese investment in manufacturing, high technology and processing industries, proved particularly successful in facilitating investment. This was especially yes after its restructure in early 1994 when it moved away from broad educational efforts towards specific investment projects which matched potential investors with Australian firms. With a focus on areas in which Australia held comparative advantages, such as processed foods and further processing of raw materials, the effectiveness of investment promotion increased dramatically and Australian exports to Japan and the Asia Pacific region expanded considerably

"Living in a Communal Garden" Associated with Well-Being While Reducing Urban Sprawl by 40%: A Mixed-Methods Cross-Sectional Study.

This is the final published version. It first appeared at http://dx.doi.org/10.3389/fpubh.2015.00173BACKGROUND: The extent to which novel land-efficient neighborhood design can promote key health behaviors is examined, concentrating on communal outdoor space provision (COSP). OBJECTIVES: To test whether a neighborhood (Accordia) with a higher ratio of communal to private outdoor space is associated with higher levels of resident's (a) self-reported local health behaviors and (b) observed engagement in local health behaviors, compared to a matched neighborhood with lower proportion of COSP. METHODS: Health behaviors were examined via direct observation and postal survey. Bespoke observation codes and survey items represented key well-being behaviors including "connecting," "keeping active," "taking notice," "keep learning," and "giving." The questionnaire was validated using psychometric analyses and observed behaviors were mapped in real-time. RESULTS: General pursuit of health behaviors was very similar in both areas but Accordia residents reported substantially greater levels of local activity. Validated testing of survey dataset (n = 256) showed support for a stronger Attitude to Neighborhood Life (connecting and giving locally) in Accordia and partial support of greater physical activity. Analyses of the behavior observation dataset (n = 7,298) support the self-reported findings. Mapped observations revealed a proliferation of activity within Accordia's innovative outdoor hard spaces. CONCLUSION: Representation is limited to upper-middle class UK groups. However, Accordia was found to promote health behaviors compared a traditional neighborhood that demands considerably more land area. The positive role of home zone streets, hard-standing and semi-civic space highlights the principle of quality as well as quantity. The findings should be considered as part of three forthcoming locally led UK garden cities, to be built before 2020.This research was supported by the Engineering and Physical Sciences Research Council, grant number EP/P505445/1. Special thanks is directed toward Ian Cray and Peter Danson of the Accordia Resident Association and Richard Footitt of the Richmond Road Resident Association, in Castle. Gratitude is also extended to Professor Huppert (Department of Psychiatry), Professor Steemers (Department of Architecture), Prof. Mark Haggard (Department of Psychology) and Dr. David Olgivie (Centre for Activity and Environment Research) based at the University of Cambridge for their support throughout the study and Professor Florian Kaiser at Otto-von-Guericke University

Determinants of farmer adoption of organic production methods in the fresh-market produce sector in California: A logistic regression analysis

This research uses binomial and multinomial logistic regression models to identify the factors that influence farmers adoption of organic technology. Using a sample of 175 farmers growing fresh-market produce in three California counties, the first model examines farmers choice between conventional-only and organic-only production. The second model compares conventional-only and "dual-method" (combined conventional and organic) production, while the third model employs all three choices in a multinomial model. These results, which indicate that gross sales, direct marketing, number of crops and acres, farmer age, and computer usage are significant determinants, have implications on policies that regulate the organic foods sector.Production Economics,

Climate change and the Delta, San Francisco Estuary and Watershed Science

Anthropogenic climate change amounts to a rapidly approaching, “new” stressor in the Sacramento–San Joaquin Delta system. In response to California’s extreme natural hydroclimatic variability, complex water-management systems have been developed, even as the Delta’s natural ecosystems have been largely devastated. Climate change is projected to challenge these management and ecological systems in different ways that are characterized by different levels of uncertainty. For example, there is high certainty that climate will warm by about 2°C more (than late-20th-century averages) by mid-century and about 4°C by end of century, if greenhouse-gas emissions continue their current rates of acceleration. Future precipitation changes are much less certain, with as many climate models projecting wetter conditions as drier. However, the same projections agree that precipitation will be more intense when storms do arrive, even as more dry days will separate storms. Warmer temperatures will likely enhance evaporative demands and raise water temperatures. Consequently, climate change is projected to yield both more extreme flood risks and greater drought risks. Sea level rise (SLR) during the 20th century was about 22cm, and is projected to increase by at least 3-fold this century. SLR together with land subsidence threatens the Delta with greater vulnerabilities to inundation and salinity intrusion. Effects on the Delta ecosystem that are traceable to warming include SLR, reduced snowpack, earlier snowmelt and larger storm-driven streamflows, warmer and longer summers, warmer summer water temperatures, and water-quality changes. These changes and their uncertainties will challenge the operations of water projects and uses throughout the Delta’s watershed and delivery areas. Although the effects of climate change on Delta ecosystems may be profound, the end results are difficult to predict, except that native species will fare worse than invaders. Successful preparation for the coming changes will require greater integration of monitoring, modeling, and decision making across time, variables, and space than has been historically normal

Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012.

BackgroundAlthough the incidence of gastroschisis is increasing, risk factors are not clearly identified.MethodsUsing the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis.ResultsThe prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08-16.21, p < 0.001) and preterm birth (OR 3.26-10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24-1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs.$9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%.ConclusionsThis is the largest population-based study summarizing current epidemiology of gastroschisis in California.Type of studyRetrospective comparative cohort study.Level of evidenceIII

Assessing reservoir operations risk under climate change

Risk-based planning offers a robust way to identify strategies that permit adaptive water resources management under climate change. This paper presents a flexible methodology for conducting climate change risk assessments involving reservoir operations. Decision makers can apply this methodology to their systems by selecting future periods and risk metrics relevant to their planning questions and by collectively evaluating system impacts relative to an ensemble of climate projection scenarios (weighted or not). This paper shows multiple applications of this methodology in a case study involving California\u27s Central Valley Project and State Water Project systems. Multiple applications were conducted to show how choices made in conducting the risk assessment, choices known as analytical design decisions, can affect assessed risk. Specifically, risk was reanalyzed for every choice combination of two design decisions: (1) whether to assume climate change will influence flood-control constraints on water supply operations (and how), and (2) whether to weight climate change scenarios (and how). Results show that assessed risk would motivate different planning pathways depending on decision-maker attitudes toward risk (e.g., risk neutral versus risk averse). Results also show that assessed risk at a given risk attitude is sensitive to the analytical design choices listed above, with the choice of whether to adjust flood-control rules under climate change having considerably more influence than the choice on whether to weight climate scenarios

Psychosocial development in youth soccer players: Assessing the effectiveness of the 5C’s intervention program.

This study examined the effectiveness of a longitudinal 5C coaching intervention (Harwood, 2008), focused on promoting behavioral responses associated with commitment, communication, concentration, control, and confidence in youth soccer players. Five players, their parents and a youth academy soccer coach participated in a single-case multiple-baseline across individuals design with multiple treatments. Following baseline, the coach received sequential education in the principles of each ‘C’ subsequent to integrating relevant strategies in their coaching sessions. During the five intervention phases, players completed assessments of their behavior in training associated with each C, triangulated with observation-based assessments by the coach and the players’ parents. Results indicated psychosocial improvements with cumulative increases in positive psychosocial responses across the intervention for selected players. Changes in player behavior were also corroborated by parent and coach data in conjunction with post-intervention social validation. Findings are discussed with respect to the processes engaged in the intervention, and the implications for practitioners and applied researchers

The effect of changing the built environment on physical activity: a quantitative review of the risk of bias in natural experiments.

BACKGROUND:Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity.METHODS:Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar systematic reviews; these were published in the past five years and were selected to provide a range of different built environment interventions. The risk of bias in these studies was analysed using the Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI).RESULTS:Twelve eligible natural experiments were identified. Risk of bias assessments were conducted for each physical activity outcome from all studies, resulting in a total of fifteen outcomes being analysed. Intervention sites included parks, urban greenways/trails, bicycle lanes, paths, vacant lots, and a senior citizen's centre. All outcomes had an overall critical (n = 12) or serious (n = 3) risk of bias. Domains with the highest risk of bias were confounding (due to inadequate control sites and poor control of confounding variables), measurement of outcomes, and selection of the reported result.CONCLUSIONS:The present review focused on the strongest natural experiments conducted to date. Given this, the failure of existing studies to adequately control for potential sources of bias highlights the need for more rigorous research to underpin policy recommendations for changing the built environment to increase physical activity. Suggestions are proposed for how future natural experiments in this area can be improved

Chapter 3 : Japanese literature and “Homeland/Hometown”

Accompanying guidance document used to help assessors judge the risk of bias in each bias domain and overall risk of bias. (DOCX 29 kb