Prescribing Protocol for Postoperative Opioids in an Orthopedic Spine Practice

Problem: The opioid epidemic is magnified by excessive post-surgery prescriptions. Over six months at an orthopedic spine practice, 50% of patients received two or more opioid refills beyond their first. This highlighted the absence of a clear prescribing policy and emphasized the need for a structured protocol and to promote patient safety. Aim of the Project: The primary aim was to implement a prescribing protocol to lower opioid refills provided to post-surgical patients in this surgical practice. The desired result was to reduce the number of opioid refills provided to patients after surgery. Review of the Evidence: Evidence highlighted substantial support for prescribing protocols. Utilizing specific post-surgery opioid prescribing methods may reduce opioid use and refills. The project protocol, modeled after the University of Michigan’s Pain Management Toolkit patient agreement, was developed using multiple national guidelines. Project Design: This quality improvement project employed the Institute for Healthcare Improvement’s Plan-Do-Study-Act model. After each cycle, the team analyzed data to pinpoint areas for improvement. The OhioHealth Change Management model tools were crucial in steering the change process. Challenges were discussed in brainstorming sessions, and solutions were devised and implemented to address these obstacles. Intervention: Before surgery, patients signed the project protocol which was reviewed once more on the day of surgery. This protocol encompassed a weaning plan and highlighted alternative pain control methods. At each post-operative check, surveys gauged pain levels and compliance, ensuring consistent adherence. Significant Findings/Outcomes: The first outcome aimed to reduce the number of opioid refills prescribed by 75%, and it surpassed this goal by reaching 97%. The second outcome was achieved, ensuring all patients requiring medication beyond eight weeks were referred to pain management or primary care. Additionally, 97% of patients signed the protocol prior to surgery. Implications for Nursing: This project aligns with the Six Aims of Healthcare Quality outlined by the Institute of Medicine and promoted by the Agency for Healthcare Research and Quality: to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. Additionally, in line with the Institute for Healthcare Improvement\u27s Triple Aim, the project protocol advances better patient outcomes, improves the patient experience, and addresses the opioid crisis by reducing over-prescribing post-surgery

E-waste Management Policy in India - Stakeholders perceptions and media attention

E-waste is one of the fastest growing waste streams in India due to an increase in consumption from businesses and domestic users. There is no separate law on e-waste management in India and it is presently interpreted under the Hazardous Waste (HW) rules. In practice, e-waste is largely handled by people in the informal sector. Having recognized the need for a separate policy on e-waste management, some NGOs and bi-lateral agencies put concerted efforts in 2006 but the process has not progressed considerably in the last two years. This research has been conducted to understand the policy making process which is influenced by the perceptions of different stakeholders and the media. The policy core beliefs of stakeholders on various topics such as the threat of e-waste on health and the environment, the need of a separate policy on e-waste, the applicability of the extended producer responsibility (EPR) policy principle, responsibilities of various stakeholders and the most affected parties due to a possible policy are investigated through semi-structured interviews and questionnaires. The media has been analyzed to understand the reasons for the variations in media attention during 2003-2007. The study finds that the policy making process has not considerably progressed due to (1) the differences in the beliefs of civil servants and experts and those of NGOs and bi-lateral agencies and (2) a decrease of the media coverage of the issue in the last two years. In addition, the principle of EPR has been misconceptualised as mere take-back scheme and the WEEE Directive in the European Union has been, unfortunately, viewed as the model for EPR legislations. This misinterpretation of the EPR policy principle might contribute to the slowdown of the development of a separate e-waste policy in India

Emulsifying properties of hemp proteins: Effect of isolation technique

peer-reviewedHemp protein was isolated from hemp seed meal using two different isolation procedures: alkali extraction/isoelectric precipitation (HPI) and micellization (HMI). The ability of these proteins to form and stabilize 10% (w/w) sunflower oil-in-water emulsions (at pH = 3.0) was studied at three different concentrations, 0.25, 0.75 and 1.5% (w/w), by monitoring emulsion droplet size distribution, microstructural and morphological properties, rheological behaviour and stability against flocculation, coalescence and creaming. In addition, hemp proteins were analysed for water solubility, denaturation degree and surface/interfacial activity. HMI protein, which was found to be less denatured after isolation, exhibited higher solubility and slightly higher surface/interfacial activity than HPI protein. HMI emulsions possessed a smaller volume mean droplet diameter (d4,3 = 1.92–3.42 μm in 2% SDS) than HPI emulsions (d4,3 = 2.25–15.77 μm in 2% SDS). While HMI stabilized emulsions were characterized with individual droplets covered by protein film, both confocal laser scanning microscopy and flocculation indices indicated occurrence of bridging flocculation in HPI stabilized emulsions. Protein aggregation, which induced flocculation of the droplets, contributed to higher apparent viscosity of HPI stabilized emulsions compared to HMI stabilized emulsions. Interestingly, emulsions stabilized with 1.5% (w/w) HPI exhibited much better creaming and coalescence stability than other emulsions due to the formation of a weak transient network of floccules and higher continuous phase viscosity which both suppressed the movement of the droplets

Work function determination of promising electrode materials for thermionic energy converters

The work function determinations of candidate materials for low temperature (1400 K) thermionics through vacuum emission tests are discussed. Two systems, a vacuum emission test vehicle and a thermionic emission microscope are used for emission measurements. Some nickel and cobalt based super alloys were preliminarily examined. High temperature physical properties and corrosion behavior of some super alloy candidates are presented. The corrosion behavior of sodium is of particular interest since topping cycles might use sodium heat transfer loops. A Marchuk tube was designed for plasma discharge studies with the carbide and possibly some super alloy samples. A series of metal carbides and other alloys were fabricated and tested in a special high temperature mass spectrometer. This information coupled with work function determinations was evaluated in an attempt to learn how electron bonding occurs in transition alloys

The poverty impacts of improved cowpea varieties in Nigeria: a counterfactual analysis

Open Access Article; Published online: 12 June 2019Adoption of improved agricultural technologies has long been recognized as critical for reducing poverty through increased productivity, incomes, and asset accumulation. Using a nationally representative survey data from a sample of over 1500 households in Nigeria, this paper evaluates the impacts of adoption of improved cowpea varieties on income and asset poverty reduction using an endogenous switching regression model. The results showed that adoption of improved cowpea varieties increased per capita household income and asset ownership by 17 and 24 percentage points, respectively. The results based on the observed and counterfactual income and asset distributions further showed that adoption reduced both income poverty and asset poverty by 5 percentage points. The paper concludes with a discussion of the policy options for increasing adoption and impacts of improved cowpea varieties in Nigeria

Use of Participatory Forest Management as a Strategy for Sustainability of Kazimzumbwi and Pugu Forest Reserves, Tanzania

This study investigated the strategies for improving access to and use of information for forest management with particular reference to Kazimzumbwi and Pugu forest reserves in Coast Region located in the Pugu Hills area, about 20 km south-west of Dar es Salaam, in Tanzania. The review of literature and preliminary findings indicate that the majority of the people in developing countries, especially in rural areas depend on forests for multiple purposes such as construction materials, medicine, fodder, fuel wood, and domestic utensils. Moreover, the levels of forest degradation and deforestation are on the increase due to population pressure on forest resources, economic activities and climate change which are major challenges threatening forest resources. The findings also indicate that the Tanzania government recognises Participatory Forest Management (PFM) as a right strategy for effective forest management and sustainable forest use. Although PFM plays a central role in Tanzania’s forest laws and policies, there is still a high rate of deforestation and forest degradation resulting in the reduction of forests to almost a half of the forests because of illegal activities. This could, to some extent, be attributed to rural communities’ inadequate access to and use of information for forest management. Since it is acknowledged that access to and use of information is critical in forest management it is recommended that the flow of information be closely monitored to minimise any obstructions. Secondly, the information communicated should be repackaged for ease of access and use by the majority of people, especially the targeted group in rural areas, who cannot understand scientific information. Thirdly, since general mass media, groups such as youth and women, awareness campaigns, and involvement in civil society activities are the real information transmission belts in communities, which bring immediate positive impacts, they should be effectively used by forest agencies.Key Words: Participatory Forest Management, Access to Information, Kazimzumbwi Forest Reserve, Pugu Forest Reserve, Tanzani

INDONESIA DAN ASEAN DALAM PERGERAKAN ORANG PERSEORANGAN: TINJAUAN ASEAN AGREEMENT ON THE MOVEMENT OF NATURAL PERSONS (ASEAN AMNP) TERHADAP PERGERAKAN TENAGA KERJA

Adanya pasar tunggal ASEAN yang demikian pun tidak lepas dari pentingnya menumbuhkembangkan hubungan keimigrasian antarnegara anggota ASEAN, tak terkecuali Indoensia. Secara alami, Indonesia memegang peran sebagai natural leader di kawasan Asia Tenggara Langkah untuk mewujudkan single market ASEAN yang berdaya saing pun tidak lepas dari konteks keimigrasian, tepatnya hubungan keimigrasian di ASEAN. Artikel ini akan membahas tentang hubungan keimigrasian Indonesia dengan ASEAN, spesifiknya yang berkaitan dengan “perpindahan orang dalam kegiatan perdagangan barang, perdagangan jasa, dan investasi di antara Negara-negara Anggota ASEA

Teaching Speaking Through Total Immersion Program at The Ninth Grade of SMP Negeri 3 Panca Rijang

The aims of this article is to describe that total immersion program in teaching English can improve students speaking ability. This article is made from research result which used pre- test and post-test design. The population of the article is the ninth grade of SMP Negeri 3 Panca Rijang there are two classes. The writer applied random technique that took one of the two class and sample of this article was IX.2 class with 20 students. The instrument of this article was speaking test which would be administred in pre-test and post-test. The pre-test would be used to find the prior knowledge of speaking ability, while post-test would be used to find speaking ability achievement after treatment is given. The result of this article showed that total immersion program was effective to improve speaking ability at the ninth grade of SMP Negeri 3 Panca Rijang especially IX.2 class. It could be proved from their mean score in post-test (56.95) was higher than their mean score in pre-test (48.50), and the t-test value (10.934) was greater than t-table (a = 0.05; df= 9; t table = 2.262, this means that H1 was accepted

Stressor-Induced Increase in Muscle Fatigability of Young Men and Women is Predicted by Strength but Not Voluntary Activation

This study investigated mechanisms for the stressor-induced changes in muscle fatigability in men and women. Participants performed an isometric-fatiguing contraction at 20% maximal voluntary contraction (MVC) until failure with the elbow flexor muscles. Study one (n = 55; 29 women) involved two experimental sessions: 1) a high-stressor session that required a difficult mental-math task before and during a fatiguing contraction and 2) a control session with no mental math. For some participants (n = 28; 14 women), cortical stimulation was used to examine mechanisms that contributed to muscle fatigability during the high-stressor and control sessions. Study two (n = 23; nine women) determined the influence of a low stressor, i.e., a simple mental-math task, on muscle fatigability. In study one, the time-to-task failure was less for the high-stressor session than control (P \u3c 0.05) for women (19.4%) and men (9.5%): the sex difference response disappeared when covaried for initial strength (MVC). MVC force, voluntary activation, and peak-twitch amplitude decreased similarly for the control and high-stressor sessions (P \u3c 0.05). In study two, the time-to-task failure of men or women was not influenced by the low stressor (P \u3e 0.05). The greater fatigability, when exposed to a high stressor during a low-force task, was not exclusive to women but involved a strength-related mechanism in both weaker men and women that accelerated declines in voluntary activation and slowing of contractile properties