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

The production of The Death and Life of Sneaky Fitch .

OPTION II PROJECT PROPOSAL For my Option II project, I propose to design and direct a Blair High School production of The Death and Life of Sneaky Fitch, by James L. Rosenberg (Dramatists Play Service, Inc.). Using high school students as actors and workers, the production will be presented November 8, 9, 10, 1979 at the Blair Highschool theatre. Since my career choice is in educational theatre it is fitting that this project deal with high school students

A role for recurrent processing in object completion: neurophysiological, psychophysical and computational"evidence

Recognition of objects from partial information presents a significant challenge for theories of vision because it requires spatial integration and extrapolation from prior knowledge. We combined neurophysiological recordings in human cortex with psychophysical measurements and computational modeling to investigate the mechanisms involved in object completion. We recorded intracranial field potentials from 1,699 electrodes in 18 epilepsy patients to measure the timing and selectivity of responses along human visual cortex to whole and partial objects. Responses along the ventral visual stream remained selective despite showing only 9-25% of the object. However, these visually selective signals emerged ~100 ms later for partial versus whole objects. The processing delays were particularly pronounced in higher visual areas within the ventral stream, suggesting the involvement of additional recurrent processing. In separate psychophysics experiments, disrupting this recurrent computation with a backward mask at ~75ms significantly impaired recognition of partial, but not whole, objects. Additionally, computational modeling shows that the performance of a purely bottom-up architecture is impaired by heavy occlusion and that this effect can be partially rescued via the incorporation of top-down connections. These results provide spatiotemporal constraints on theories of object recognition that involve recurrent processing to recognize objects from partial information

Sensitivity to Timing and Order in Human Visual Cortex

Visual recognition takes a small fraction of a second and relies on the cascade of signals along the ventral visual stream. Given the rapid path through multiple processing steps between photoreceptors and higher visual areas, information must progress from stage to stage very quickly. This rapid progression of information suggests that fine temporal details of the neural response may be important to the how the brain encodes visual signals. We investigated how changes in the relative timing of incoming visual stimulation affect the representation of object information by recording intracranial field potentials along the human ventral visual stream while subjects recognized objects whose parts were presented with varying asynchrony. Visual responses along the ventral stream were sensitive to timing differences between parts as small as 17 ms. In particular, there was a strong dependency on the temporal order of stimulus presentation, even at short asynchronies. This sensitivity to the order of stimulus presentation provides evidence that the brain may use differences in relative timing as a means of representing information.Comment: 10 figures, 1 tabl

Managing tribal assets: Developing long term strategic plans: Working paper series--98-01

As Native American tribes move toward self-determination with their governments and self-sufficiency of their peoples, they face daunting problems. Beginning from the status quo of unemployment rates ranging as high as 90%, concomitant social and health issues unseen elsewhere in the U.S., and limited financial assets, tribes need to develop long-term strategic plans. However, traditional economic development models and techniques are of little use in designing these plans. Additionally, some tribes are earning substantial financial assets through gaming operations. Nearly all tribes, however, still face the challenge of using their assets to build vibrant communities after many years of destitution. To this end, the development of a long-term strategic community development plan is called for. The National Executive Education Program for Native American Leadership (NEEPNAL) in conjunction with the Center for American Indian Economic Development (CAIED) has developed a method for aiding tribes to develop such plans. This paper addresses the multiple, difficult issues surrounding development of an effective long-term strategic planning process for productive uses of tribal assets. Further, the NEEPNAL/CAIED method for overcoming these difficulties is presented, with positive examples from tribal experience

Using Rubrics To Assess Accounting Students Writing, Oral Presentations, And Ethics Skills

This paper presents examples of rubrics that can be used in the assessment of the acquisition of generic skills in accounting education. A rubric is a matrix containing the various factors of an assignment along one dimension (rows) and descriptors of the qualitative levels of accomplishment along the other dimension (columns). A rubric can facilitate the grading of assignments and help students improve their generic skills. Examples of rubrics are presented that educators may find beneficial to enhance the generic skills of their students. This paper illustrates five different rubrics and provides an in-depth discussion on how the ethics rubric was used to assess students learning

Project Selection and Process Plan Design for Alternative IME 143/144 Final Project

Hundreds of students each year enroll in IME 143 or IME 144, freshman-level machining classes, and complete an air motor to demonstrate the skills they have acquired on a variety of manufacturing processes. The air motor, however is useful only as a teaching tool in the classroom; once the students bring them home, the air motor becomes little more than a trophy at best. With the capabilities of the machining lab, a final project can be developed that can have a benefit to people in need while maintaining educational value. This project details a process plan for a manual water pump. The pump can be donated for use in developing countries where access to clean water is still in desperate need. The process for manufacturing the water pump had to be deconstructed into specific machining processes and balanced appropriately between the machines available to the classes. The machining lab has a number of different machines that enable students to use 14 different processes. Unlike a production environment, all processes have to be used and balanced to make use of lab time. This often meant using sub-optimal processes and/or procedures. The critical benchmark for implementing the water pump into the curriculum is the cost. Students in IME 143/144 pay lab fees, which cover the cost of materials for the quarter. The fees are $10 for IME 143 and$50 for IME 144. Based on rough estimates from these lab fees, the actual cost of the air motor is between $10 and$20. As designed currently, the water pump has a material cost of about $30. However, this project is larger and more complex. It is recommended that one pump be made for every two students bringing the per student cost to about$15, within the cost range of the air motor

Derivation of normal macrophages from human embryonic stem (hES) cells for applications in HIV gene therapy

BACKGROUND: Many novel studies and therapies are possible with the use of human embryonic stem cells (hES cells) and their differentiated cell progeny. The hES cell derived CD34 hematopoietic stem cells can be potentially used for many gene therapy applications. Here we evaluated the capacity of hES cell derived CD34 cells to give rise to normal macrophages as a first step towards using these cells in viral infection studies and in developing novel stem cell based gene therapy strategies for AIDS. RESULTS: Undifferentiated normal and lentiviral vector transduced hES cells were cultured on S17 mouse bone marrow stromal cell layers to derive CD34 hematopoietic progenitor cells. The differentiated CD34 cells isolated from cystic bodies were further cultured in cytokine media to derive macrophages. Phenotypic and functional analyses were carried out to compare these with that of fetal liver CD34 cell derived macrophages. As assessed by FACS analysis, the hES-CD34 cell derived macrophages displayed characteristic cell surface markers CD14, CD4, CCR5, CXCR4, and HLA-DR suggesting a normal phenotype. Tests evaluating phagocytosis, upregulation of the costimulatory molecule B7.1, and cytokine secretion in response to LPS stimulation showed that these macrophages are also functionally normal. When infected with HIV-1, the differentiated macrophages supported productive viral infection. Lentiviral vector transduced hES cells expressing the transgene GFP were evaluated similarly like above. The transgenic hES cells also gave rise to macrophages with normal phenotypic and functional characteristics indicating no vector mediated adverse effects during differentiation. CONCLUSION: Phenotypically normal and functionally competent macrophages could be derived from hES-CD34 cells. Since these cells are susceptible to HIV-1 infection, they provide a uniform source of macrophages for viral infection studies. Based on these results, it is also now feasible to transduce hES-CD34 cells with anti-HIV genes such as inhibitory siRNAs and test their antiviral efficacy in down stream differentiated cells such as macrophages which are among the primary cells that need to be protected against HIV-1 infection. Thus, the potential utility of hES derived CD34 hematopoietic cells for HIV-1 gene therapy can be evaluated

Leadership quality and follower affect - A study of U.S. presidential candidates: Working paper series--07-02

Using data from the seven most recent US presidential elections, two related analyses are conducted. The first presents an analysis of variance comparing Democratic and Republican Party candidates who were successful in securing votes to those who were unsuccessful in securing votes, using follower perceptions of candidate intelligence, candidate's degree of charisma, and follower feelings of positive and negative affect toward these candidates as the units for analysis. Here, perceived intelligence, feelings of pride and hope, as well as feelings of fear and anger, were found to be statistically different between the two groups. Specifically, candidates perceived to be higher in intelligence, who generated stronger feelings of pride and hope, and weaker feelings of fear and anger were more likely to receive voting support from their followers. The second analysis presents a regression model using follower assessments of candidates' leadership quality as dependent upon certain leader perceptual traits, including follower assessments of candidate intelligence and inspirational qualities, as well as follower affective responses (in terms of feelings of pride, hope, fear and anger) toward all candidates. Here, candidates perceived to be higher in intelligence, perceived to possess stronger degrees of inspirational quality, and who were judged more "likeable" in terms of generating stronger degrees of positive follower affect and lower degrees of negative follower affect are considered better quality leaders

Type Ibc supernovae in disturbed galaxies: evidence for a top-heavy IMF

We compare the radial locations of 178 core-collapse supernovae to the R-band and H alpha light distributions of their host galaxies. When the galaxies are split into `disturbed' and `undisturbed' categories, a striking difference emerges. The disturbed galaxies have a central excess of core-collapse supernovae, and this excess is almost completely dominated by supernovae of types Ib, Ic and Ib/c, whereas type II supernovae dominate in all other environments. The difference cannot easily be explained by metallicity or extinction effects, and thus we propose that this is direct evidence for a stellar initial mass function that is strongly weighted towards high mass stars, specifically in the central regions of disturbed galaxies.Comment: 22 pages, 5 figures, accepted for publication in Ap