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

Ecología del género Blaps Fabricius, 1775 en el sudeste ibérico (Coleoptera, Tenebrionidae)

Se aborda el estudio de la ecología de las especies del género Blaps Fabricius, 1775 presentes en el sudeste ibérico: Blaps gigas (Linnaeus, 1767), Blaps hispanica Solier, 1848, Blaps lusitanica Herbst, 1799 y Blaps sulcata brachyura (Linnaeus, 1767). Se analiza la distribución espacial y temporal de las especies estudiadas, a lo largo de un ciclo anual, en orden a inferir patrones de relación con el medio en el que se encuentran, analizando la influencia de factores ambientales como el tipo de suelo, vegetación, temperaturas y precipitaciones.Ecology of the genus Blaps Fabricius, 1775 from the south eastern Iberian Peninsula (Coleoptera, Tenebrionidae). The ecologic study of different species in genus Blaps Fabricius, 1775 of the south eastern Iberian Peninsula as Blaps gigas (Linnaeus, 1767), Blaps hispanica Solier, 1848, Blaps lusitanica Herbst, 1799 and Blaps sulcata brachyura (Linnaeus, 1767), was carried out on different habitats. The spatial and seasonal activity during an anual cycle were studied. The influence of several evironmental characteristics as type of soil, vegetation, temperature, rainfall and their effects in the distribution of these species, were also assessed

The Biological Station Torretes (Ibi, Alicante): a space for the conservation of odonates

Los odonatos son indicadores biológicos de la calidad de los medios acuáticos, ya que requieren, en la mayoría de los casos, aguas limpias y bien oxigenadas para desarrollar sus etapas larvarias. Muchas especies han sido incluidas en la Lista Roja de especies amenazadas. Se ha llevado a cabo un estudio de la fauna de Odonatos en la Estación Biológica Torretes - Jardín Botánico de la Universidad de Alicante (Ibi, Alicante), un espacio de bosque mediterráneo de 53 hectáreas, que está gestionado por el Instituto de Investigación CIBIO de la Universidad de Alicante. Este centro está destinado a investigar y difundir el valor de la biodiversidad y la conservación. Se han estudiado diversos puntos de agua permanentes con el objetivo de determinar áreas de conservación de la biodiversidad. En la estación biológica se registraron 16 especies de odonatos de los 28 citadas en ambientes naturales para la provincia de Alicante, lo que resaltan la importancia de este espacio natural en la conservación de estos insectos.Odonates are biological indicators of the aquatic environments quality, because them require, in most cases, clean and well oxygenated waters to develop their larval stages. Many species have been included in the Red List of threatened species for their vulnerability to contaminated environments. A study of odonata fauna was carried out in several permanent water points in the Biological Station – Botanical Garden of Torretes (Ibi, Alicante), a Mediterranean forest space of 53 hectares, managed by the Research Institute CIBIO of the University of Alicante. This center aims to investigate and disseminate the value of biodiversity and conservation. In the biological station was collected 16 species Odonates of the 28 reported in natural environments for the Alicante province, which highlight the importance of this natural space in the conservation and biodiversity of these insects

Study of the performance and capability of the new ultra-fast 2 GSample/s FADC data acquisition system of the MAGIC telescope

In February 2007 the MAGIC Air Cherenkov Telescope for gamma-ray astronomy was fully upgraded with an ultra fast 2 GSamples/s digitization system. Since the Cherenkov light flashes are very short, a fast readout can minimize the influence of the background from the light of the night sky. Also, the time structure of the event is an additional parameter to reduce the background from unwanted hadronic showers. An overview of the performance of the new system and its impact on the sensitivity of the MAGIC instrument will be presented.Comment: Contribution to the 30th ICRC, Merida Mexico, July 2007 on behalf of the MAGIC Collaboratio

Mass casualty events: what to do as the dust settles?

Care during mass casualty events (MCE) has improved during the last 15 years. Military and civilian collaboration has led to partnerships which augment the response to MCE. Much has been written about strategies to deliver care during an MCE, but there is little about how to transition back to normal operations after an event. A panel discussion entitled The Day(s) After: Lessons Learned from Trauma Team Management in the Aftermath of an Unexpected Mass Casualty Event at the 76th Annual American Association for the Surgery of Trauma meeting on September 13, 2017 brought together a cadre of military and civilian surgeons with experience in MCEs. The events described were the First Battle of Mogadishu (1993), the Second Battle of Fallujah (2004), the Bagram Detention Center Rocket Attack (2014), the Boston Marathon Bombing (2013), the Asiana Flight 214 Plane Crash (2013), the Baltimore Riots (2015), and the Orlando Pulse Night Club Shooting (2016). This article focuses on the lessons learned from military and civilian surgeons in the days after MCEs

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