Confronting the opioid crisis: Practical pain management and strategies: AOA 2018 critical issues symposium

The United States is in the midst of an opioid crisis. Clinicians have been part of the problem because of overprescribing of narcotics for perioperative pain management. Clinicians need to understand the pathophysiology and science of addiction to improve perioperative management of pain for their patients. Multiple modalities for pain management exist that decrease the use of narcotics. Physical strategies, cognitive strategies, and multimodal medication can all provide improved pain relief and decrease the use of narcotics. National medical societies are developing clinical practice guidelines for pain management that incorporate multimodal strategies and multimodal medication. Changes to policy that improve provider education, access to naloxone, and treatment for addiction can decrease narcotic misuse and the risk of addiction

Online healthy lifestyle support in the perinatal period: What do women want and do they use it?

Unhealthy weight gain and retention during pregnancy and postpartum is detrimental to mother and child. Although various barriers limit the capacity for perinatal health care providers (PHCPs) to offer healthy lifestyle counselling, they could guide women to appropriate online resources. This paper presents a project designed to provide online information to promote healthy lifestyles in the perinatal period. Focus groups or interviews were held with 116 perinatal women and 76 PHCPs to determine what online information perinatal women and PHCPs want, in what form, and how best it should be presented. The results indicated that women wanted smartphone applications (apps) linked to trustworthy websites containing short answers to everyday concerns; information on local support services; and personalised tools to assess their nutrition, fitness and weight. Suggestions for improvement in these lifestyle areas should be practical and tailored to the developmental stage of their child. PHCPs wanted evidence-based, practical information, presented in a simple, engaging, interactive form. The outcome was a clinically endorsed website and app that health professionals could recommend. Preliminary evaluation showed that 10.5% of pregnant women in Western Australia signed up to the app. Use of the app appeared to be equitable across urban and rural areas of low to middle socioeconomic status

Genome-Wide Association Study and Subsequent Exclusion of ATCAY as a Candidate Gene Involved in Equine Neuroaxonal Dystrophy Using Two Animal Models.

Equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy (eNAD/EDM) is an inherited neurodegenerative disorder of unknown etiology. Clinical signs of neurological deficits develop within the first year of life in vitamin E (vitE) deficient horses. A genome-wide association study (GWAS) was carried out using 670,000 SNP markers in 27 case and 42 control Quarter Horses. Two markers, encompassing a 2.5 Mb region on ECA7, were associated with the phenotype (p = 2.05 × 10-7 and 4.72 × 10-6). Within this region, caytaxin (ATCAY) was identified as a candidate gene due to its known role in Cayman Ataxia and ataxic/dystonic phenotypes in mouse models. Whole-genome sequence data in four eNAD/EDM and five unaffected horses identified 199 associated variants within the ECA7 region. MassARRAY® genotyping was performed on these variants within the GWAS population. The three variants within ATCAY were not concordant with the disease phenotype. No difference in expression or alternative splicing was identified using qRT-PCR in brainstem across the ATCAY transcript. Atcayji-hes mice were then used to conduct functional analysis in a second animal model. Histologic lesions were not identified in the central nervous system of Atcayji-hes mice. Additionally, supplementation of homozygous Atcayji-hes mice with 600 IU/day of dl-α-tocopheryl acetate (vitE) during gestation, lactation, and adulthood did not improve the phenotype. ATCAY has therefore been excluded as a candidate gene for eNAD/EDM

Flow Equations for Non-BPS Extremal Black Holes

We exploit some common features of black hole and domain wall solutions of (super)gravity theories coupled to scalar fields and construct a class of stable extremal black holes that are non-BPS, but still can be described by first-order differential equations. These are driven by a "superpotential'', which replaces the central charge Z in the usual black hole potential. We provide a general procedure for finding this class and deriving the associated "superpotential''. We also identify some other cases which do not belong to this class, but show a similar behaviour.Comment: LaTeX, 21 pages, 2 figures. v2: reference added, JHEP versio

Ngala Healthy You, Healthy Baby: a personalized online program to support healthy weight in pregnancy and early life

Perinatal maternal obesity is common and has significant child and maternal health consequences. Online resources have the potential to engage young mothers to adopt healthier lifestyles during pregnancy and postpartum. Intercept interviews with 53 pregnant women at antenatal clinics and focus groups with 67 new mothers at mothers’ groups and playgroups were conducted to determine preferred types and formats of online information and support. The expressed needs of women were matched to behaviour change theory to guide development of the Healthy You Healthy Baby website and Smartphone application. A mix of factual and practical online information, self-assessment, goal-setting and feedback in an interactive format is recommended to motivate and support women to achieve healthy lifestyles in the perinatal period. Referral to online resources by health professionals and quality assurance of content is important to increase the confidence of women to act on it

Can Multi-Regional Trajectory Based Operations Reduce Workload-Related Aviation Incidents?

Multi-Regional Trajectory Based Operations (MR TBO) was developed by Florida NextGen Test Bed (FTB) along with the Federal Aviation Administration (FAA) as a method for enhancing air traffic management (ATM), both domestically and internationally. TBO offers a shift from voice-based exchanges between Air Traffic Controllers and pilots to highly automated, digital communication exchanges. The purpose of this poster is twofold. First, it explains how TBO can help improve route amendments, speed change, strategic handling of ground events, and sharing and managing multiple aircraft. Second, the poster proposes the integration of MR TBO into the National Airspace System (NAS) to decrease the number of incidents caused by high workloads of ATM. Results of this poster suggest that the operational value of adopting MR TBO extends towards the airlines, pilots, and air traffic controllers. A resulting increase of efficiency and safety will revolutionize the NAS for future generations of the aviation industry

High-flow nasal cannula implementation has not reduced intubation rates for bronchiolitis in Canada

Background and Objective: Bronchiolitis is the most common reason for admission to hospital in the first year of life, with increasing hospitalization rates in Canada. Respiratory support with high-flow nasal cannula (HFNC) is being routinely used in paediatric centres, though the evidence of efficacy is continuing to be evaluated. We examined the impact of HFNC on intubation rates, hospital and paediatric critical care unit (PCCU) length of stay (LOS), and PCCU admission rates in paediatric tertiary centres in Canada. Methods: We conducted a multicentre, interrupted time series analysis to examine intubation rates pre- to postimplementation of HFNC for bronchiolitis. Data were obtained from the Canadian Institute for Health Information database. Paediatric tertiary centres that introduced HFNC between 2009 and 2014 were included, and data were collected from April 2005 to March 2017. Results: A total of 17,643 patients met inclusion criteria. There was no significant change in intubation rates after the introduction of HFNC. There was a significant increase in PCCU admission, with a decrease in the PCCU LOS following the introduction of HFNC. There was no significant change in average hospital LOS after HFNC was introduced. Conclusions: This study adds to the evolving evidence showing that overall disease course is not modified by the use of HFNC. The initiation of HFNC in Canadian paediatric centres resulted in no significant change in intubation rates or average LOS in hospital, but had an increase in PCCU admissions. Careful monitoring of new technologies on their clinical impact as well as health care resource utilization is warranted

Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi

Despite the increasing burden, breast cancer control in sub-Saharan Africa is insufficient. Late diagnosis and lack of early detection and screening services contribute to high mortality. Clinical breast exam (CBE) screening can be valuable in low-income countries, including use of community health workers and non-health professionals to conduct exams. We assessed experiences of women who underwent CBE screening by trained laywomen in Lilongwe, Malawi, as part of a pilot program

Electron Transfer by Excited Benzoquinone Anions: Slow Rates for Two-Electron Transitions

Electron transfer (ET) rate constants from the lowest excited state of the radical anion of benzoquinone, BQ−•*, were measured in THF solution. Rate constants for bimolecular electron transfer reactions typically reach the diffusion-controlled limit when the free-energy change, ΔG°, reaches −0.3 eV. The rate constants for ET from BQ−•* are one-to-two decades smaller at this energy and do not reach the diffusion-controlled limit until −ΔG° is 1.5−2.0 eV. The rates are so slow probably because a second electron must also undergo a transition to make use of the energy of the excited state. Similarly, ET, from solvated electrons to neutral BQ to form the lowest excited state, is slow, while fast ET is observed at a higher excited state, which can be populated in a transition involving only one electron. A simple picture based on perturbation theory can roughly account for the control of electron transfer by the need for transition of a second electron. The picture also explains how extra driving force (−ΔG°) can restore fast rates of electron transfer

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people’s experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS. Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified. Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual’s ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed. Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term