The Efficacy of Peripheral Opioid Antagonists in Opioid-Induced Constipation and Postoperative Ileus: A Systematic Review of the Literature.

Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in treating either opioid-induced constipation or postoperative ileus. Peripherally acting μ-opioid receptor antagonists may be effective in treating both opioid-induced bowel dysfunction and postoperative ileus, but definitive conclusions are not possible because of study inconsistency and the relatively low quality of evidence. Comparisons of agents are difficult because of heterogeneous end points and no head-to-head studies

Oak forest carbon and water simulations:Model intercomparisons and evaluations against independent data

Models represent our primary method for integration of small-scale, process-level phenomena into a comprehensive description of forest-stand or ecosystem function. They also represent a key method for testing hypotheses about the response of forest ecosystems to multiple changing environmental conditions. This paper describes the evaluation of 13 stand-level models varying in their spatial, mechanistic, and temporal complexity for their ability to capture intra- and interannual components of the water and carbon cycle for an upland, oak-dominated forest of eastern Tennessee. Comparisons between model simulations and observations were conducted for hourly, daily, and annual time steps. Data for the comparisons were obtained from a wide range of methods including: eddy covariance, sapflow, chamber-based soil respiration, biometric estimates of stand-level net primary production and growth, and soil water content by time or frequency domain reflectometry. Response surfaces of carbon and water flux as a function of environmental drivers, and a variety of goodness-of-fit statistics (bias, absolute bias, and model efficiency) were used to judge model performance. A single model did not consistently perform the best at all time steps or for all variables considered. Intermodel comparisons showed good agreement for water cycle fluxes, but considerable disagreement among models for predicted carbon fluxes. The mean of all model outputs, however, was nearly always the best fit to the observations. Not surprisingly, models missing key forest components or processes, such as roots or modeled soil water content, were unable to provide accurate predictions of ecosystem responses to short-term drought phenomenon. Nevertheless, an inability to correctly capture short-term physiological processes under drought was not necessarily an indicator of poor annual water and carbon budget simulations. This is possible because droughts in the subject ecosystem were of short duration and therefore had a small cumulative impact. Models using hourly time steps and detailed mechanistic processes, and having a realistic spatial representation of the forest ecosystem provided the best predictions of observed data. Predictive ability of all models deteriorated under drought conditions, suggesting that further work is needed to evaluate and improve ecosystem model performance under unusual conditions, such as drought, that are a common focus of environmental change discussions

Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial

Background Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Methods Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation

CORROSION STUDIES FOR A FUSED SALT-LIQUID METAL EXTRACTION PROCESS FOR THE LIQUID METAL FUEL REACTOR

Corrosion screening tests were carried out on potential materials of construction for use in a fused salt-liquid metal extraction process plant. The corrodents of interest were NaCl--KCl-- MgCl/sub 2/ eutectic, LiCl--KCl eutectic, Bi-- U fuel, and BiCl/sub 3/, either separately or in various combinations. Screening tests to determine the resistance of a wide range of commercial alloys to the corrodents were performed in static and tilting-furnace capsules. Some ceramic materials were tested in static capsules. Largerscale tests of metallic materials were conducted in thermal convection loops and in a forced circulation loop. Some of the tests were conducted isothermally at 500 deg C, and others were performed under 40 to 50 deg C temperature differences at roughly the same teinperature level. On the basis of metallographic examination of exposed test tabs and chemical analyses of corrodents, it was found that the binary and ternary eutectics by themselves produced little attack on any of the materials tested. A wide variety of materials including 1020 mild steel, 2 1/4 Cr--1 Mo alloy steel, types 304 (ELC), 310, 316, 347, 430, and 446 stainless steel, 16-1 Croloy, Inconel, Hastelloy C, Inor-8, Mo, and Ta is, therefore, available for further study. Corrosion by the ternary salt-fuel system was characteristic of that produced by the fuel alone. Alloys such as 1020 mild steel, and 1 1/4 Cr--1/ 2 Mo, and 2 1/4 Cr--1 Mo alloy steel, which are resistant to fuel, would be likely choices at present for container materials. BiCl/sub 3/ produced extensive attack on ternary salt-fuel containers when the fuel contained insufficient concentrations of oxidizable solutes. Au and Al/sub 2/O/sub 3/ were the only materials not attacked by BiCl/sub 3/ in ternary salt alone. (auth

Strain dependence of bonding and hybridization across the metal-insulator transition of VO2

Soft x-ray spectroscopy is used to investigate the strain dependence of the metal-insulator transition of VO2. Changes in the strength of the V 3d - O 2p hybridization are observed across the transition, and are linked to the structural distortion. Furthermore, although the V-V dimerization is well-described by dynamical mean-field theory, the V-O hybridization is found to have an unexpectedly strong dependence on strain that is not predicted by band theory, emphasizing the relevance of the O ion to the physics of VO2

The effects of oral contraceptives on exercise performance in women: a systematic review and meta-analysis

Background: Oral contraceptive pills (OCPs) are double agents, which downregulate endogenous concentrations of oestradiol and progesterone whilst simultaneously providing daily supplementation of exogenous oestrogen and progestin during the OCP-taking days. This altered hormonal milieu differs significantly from that of eumenorrheic women and might impact exercise performance, due to changes in ovarian hormone-mediated physiological processes. Objective: To explore the effects of OCPs on exercise performance in women and to provide evidence-based performance recommendations to users. Methods: This review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A between-group analysis was performed, wherein performance of OCP users was compared with naturally menstruating women, and a within-group analysis was conducted, wherein performance during OCP consumption was compared with OCP withdrawal. For the between-group analysis, women were phase matched in two ways: (1) OCP withdrawal versus the early follicular phase of the menstrual cycle and (2) OCP consumption versus all phases of the menstrual cycle except for the early follicular phase. Study quality was assessed using a modified Downs and Black Checklist and a strategy based on the recommendations of the Grading of Recommendations Assessment Development and Evaluation working group. All meta-analyses were conducted within a Bayesian framework to facilitate probabilistic interpretations. Results: 42 studies and 590 participants were included. Most studies (83%) were graded as moderate, low or very low quality, with 17% achieving high quality. For the between-group meta-analysis comparing OCP users with naturally menstruating women, posterior estimates of the pooled effect were used to calculate the probability of at least a small effect (d ≥ 0.2). Across the two between-group comparison methods, the probability of a small effect on performance favouring habitual OCP users was effectually zero (p < 0.001). In contrast, the probability of a small effect on performance favouring naturally menstruating women was moderate under comparison method (1) (d ≥ 0.2; p = 0.40) and small under comparison method (2) (d ≥ 0.2; p = 0.19). Relatively large between-study variance was identified for both between-group comparisons (0.5 = 0.16 [95% credible interval (CrI) 0.01-0.44] and 0.5 = 0.22 [95% CrI 0.06-0.45]). For the within-group analysis comparing OCP consumption with withdrawal, posterior estimates of the pooled effect size identified almost zero probability of a small effect on performance in either direction (d ≥ 0.2; p ≤ 0.001). Conclusions: OCP use might result in slightly inferior exercise performance on average when compared to naturally menstruating women, although any group-level effect is most likely to be trivial. Practically, as effects tended to be trivial and variable across studies, the current evidence does not warrant general guidance on OCP use compared with non-use. Therefore, when exercise performance is a priority, an individualised approach might be more appropriate. The analysis also indicated that exercise performance was consistent across the OCP cycle