Choosing Between a Rock and the Pot Place.

In the evolving field of medicinal cannabis, there are many questions and concerns broached by patients to which health care providers cannot respond with anything other than anecdotal evidence. Many simple knowledge gaps persist due to barriers to high-quality research at the institutional and state levels: barriers that, in turn, stem from the federal designation of cannabis as an illegal substance. These perspectives of a California-based pain physician on the approach to the cannabis-curious pain patient highlight the necessity of a change in the classification of cannabis to streamline research as to the benefits and risks of this now ubiquitous substance

How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

ObjectiveThe United States faces an opioid crisis. Integrating prescription drug monitoring programs into electronic health records offers promise to improve opioid prescribing practices. This study aimed to evaluate 2 different user interface designs for prescription drug monitoring program and electronic health record integration.Materials and MethodsTwenty-four resident physicians participated in a randomized controlled experiment using 4 simulated patient cases. In the conventional condition, prescription opioid histories were presented in tabular format, and computerized clinical decision support (CDS) was provided via interruptive modal dialogs (ie, pop-ups). The alternative condition featured a graphical opioid history, a cue to visit that history, and noninterruptive CDS. Two attending pain specialists judged prescription appropriateness.ResultsParticipants in the alternative condition wrote more appropriate prescriptions. When asked after the experiment, most participants stated that they preferred the alternative design to the conventional design.ConclusionsHow patient information and CDS are presented appears to have a significant influence on opioid prescribing behavior

Serratus anterior plane block as a bridge to outpatient management of severe rib fractures: a case report.

Rib fractures account for a significant number of emergency department visits each year. A patients disposition often depends on the severity of rib fractures, comorbidities, and ability to achieve adequate analgesia. We present a 44-year-old male patient with severe pain secondary to rib fractures. The initial disposition was to admit for pain control. However, upon performing a serratus anterior plane block, patient was functionally appropriate for discharge with proper return precautions. Serratus anterior plane block is within the skillset of the emergency physician and can be used to achieve analgesia for rib fractures without the sedative and respiratory depressive effects associated with opioids

Daring discourse: artificial intelligence in pain medicine, opportunities and challenges.

Artificial intelligence (AI) tools are currently expanding their influence within healthcare. For pain clinics, unfettered introduction of AI may cause concern in both patients and healthcare teams. Much of the concern stems from the lack of community standards and understanding of how the tools and algorithms function. Data literacy and understanding can be challenging even for experienced healthcare providers as these topics are not incorporated into standard clinical education pathways. Another reasonable concern involves the potential for encoding bias in healthcare screening and treatment using faulty algorithms. And yet, the massive volume of data generated by healthcare encounters is increasingly challenging for healthcare teams to navigate and will require an intervention to make the medical record manageable in the future. AI approaches that lighten the workload and support clinical decision-making may provide a solution to the ever-increasing menial tasks involved in clinical care. The potential for pain providers to have higher-quality connections with their patients and manage multiple complex data sources might balance the understandable concerns around data quality and decision-making that accompany introduction of AI. As a specialty, pain medicine will need to establish thoughtful and intentionally integrated AI tools to help clinicians navigate the changing landscape of patient care

Central venous catheter placement leading to an emergent paramedian sternotomy: a case report.

Perioperative cardiac tamponade during central venous catheter placement is rare. We present a case of tamponade from pulmonary artery injury during dialysis catheter placement resulting in complicated sternotomy and hospital course. A 52-year-old female experienced intraoperative hypotension, rapidly identified as tamponade, that was treated with an emergent paramedian sternotomy. Patient experienced postdischarge dehiscence and osteomyelitis requiring multiple reoperations. This case is the first report of a deviated paramedian sternotomy performed mainly through ribs. The complications experienced outline the importance of effective multidisciplinary knowledge of best practices to stabilize tamponade pathology, mitigating morbidity and mortality

Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Surgery.

Introduction: As cannabis use continues to increase in popularity, it is important to investigate how it impacts public health in all sectors of the population, including patients undergoing anesthetic management. This retrospective study focuses on the orthopedic trauma population presenting through an emergency department (ED) and receiving a urine drug screen (UDS) with subsequent urgent surgical intervention. We aimed to evaluate differences in response to general anesthesia in patients with exposure to THC, a major cannabinoid, compared to controls that screened negative for THC. Materials and Methods: All ED visits at UC Irvine, a level 1 trauma center between November 4, 2017 and January 7, 2020, were evaluated in this study. Only adult patients who received a UDS and underwent urgent orthopedic trauma surgery within 48 h of ED visit were included in this study. Additional inclusion criteria required an anesthesia time greater than 1 h as well as anesthesia induction and intubation while in the operating room. Overall, we analyzed a total of 221 adult patients. Discussion: When adjusting for demographic variability, there were statistically significant differences in response to general anesthesia between these two groups. The THC-positive (THC(+)) group was less likely to receive intraoperative vasopressors, had higher mean arterial blood pressure and mean diastolic blood pressure, needed less total fluid input and had a lower overall fluid balance. Chronic exposure to THC has been shown to downregulate cannabinoid 1 receptors and cause alterations in endocannabinoid tone. These are two potential mechanisms by which the THC(+) group in our study may have become more resistant to the typically observed hypotensive effects of general anesthesia. Conclusion: The present study suggests that prior use of cannabis, objectively assessed by urinalysis, results in a decreased need for blood pressure support during general anesthesia. The physiological basis for this phenomenon is unclear, but possible causes might include the downregulation of vascular cannabinoid receptor 1 and/or altered endocannabinoid levels after exposure to cannabis

Evaluación de los impactos sociales proyectados para Transmicable en torno a la estación Juan Pablo II de la Localidad Ciudad Bolívar

Trabajo de investigaciónEste proyecto ejecuta la evaluación social de los impactos que podrían ser causados por el sistema Transmicable en la comunidad Juan Pablo II en Ciudad Bolívar. Los problemas relacionados con el sistema de movilidad por cable aéreo se pueden encontrar en el texto, así como información relevante en el área de estudio, como el marco demográfico y el marco geográfico. Estos estudios se basan en la información recopilada en diferentes instituciones y empresas relacionadas con el proyecto. Los métodos utilizados para la evaluación son Ad-hoc, relación costo-beneficio y relación costo-eficiencia. Con los resultados es posible analizar la rentabilidad social del proyecto y su impacto en la comunidad.1. INTRODUCCIÓN 2. GENERALIDADES 3. PREGUNTA DE INVESTIGACIÓN 4. JUSTIFICACIÓN 5. OBJETIVOS 6. CRONOGRAMA 7. PRESUPUESTO 8. MARCOS DE REFERENCIA 9. METODOLOGÍA 10. RESULTADOS 11. PRODUCTOS A ENTREGAR 12. RESULTADOS E IMPACTO ESPERADOS 13. ESTRATEGIAS DE COMUNICACIÓN 14. CONCLUSIONES 15. BIBLIOGRAFÍA 16. ANEXOS 17. APÉNDICESEspecializaciónEspecialista en Gerencia de Obras Civile

Caracterización geoquímica y tecnológica de un depósito de cuarzo de alta pureza, localizado en cercanías de la estación Pablo Acosta, Partido de Azul, Provincia de Buenos Aires (argentina)

El cuarzo (SiO2) es un mineral ampliamente utilizado en varias industrias. Sus aplicaciones dependen de sus propiedades físicas y químicas y del contenido de impurezas que poseen los cristales. El cuarzo más requerido es aquel de alta pureza (CAP), sin embargo, los yacimientos de este tipo son mundialmente escasos. En el partido de Azul, se determinó la presencia de un cuerpo rocoso de dimensiones considerables compuesto casi totalmente por cuarzo. El estudio petrográfico permitió determinar cristales de cuarzo de variable dimensión (70-600 µm) y de filosilicatos (escasos). Además, se reconocieron microestructuras de deformación dúctil y frágil. Los análisis geoquímicos realizados en dos muestras, sin y con preselección manual, indicaron contenidos de SiO2 de 95 y 97 % respectivamente, y contenidos menores de Al2O3 (< 1,50 %), Fe2O3 (< 0,55 %) y K2O (< 0,50 %). Por otro lado, se observaron escasas inclusiones fluidas. De acuerdo con los resultados obtenidos el cuerpo cuarzoso estudiado cumple con las condiciones establecidas para ser clasificado como CAP. Considerando los requerimientos de las distintas industrias, este mineral podría ser utilizado, sin ningún tipo de tratamiento, en la industria de las ferroaleaciones, y en el caso de aplicar algún método de purificación, en la industria del vidrio.Quartz (SiO2) is a known mineral that has important applications in various industries. ese applications mainly dependonits physical and chemical properties and on the impurity contents it contains. High-purity quartz (HPQ) is the most required but this deposit type is globally scarce. e presence of a rock body with considerable dimension and almost entirely composed of quartz was determined in the city of Azul. Petrographic studies revealed quartz crystals (70-600 µm) and a few phyllosilicate crystals. In addition, ductile and fragile deformation microstructures were recognized. Geochemical analyzes carried out on two samples, without and with manual preselection, indicated SiO₂ contents of 95-97 wt. %, and low contents of Al₂O₃ (<1.50 wt.%), Fe₂O₃ (<0.55 wt.%) and K₂O (<0.50 wt.%). On the other hand, a few fluid inclusions were observed. According to the obtained results, the studied quartz body reachesout to the conditions established to be classified as HPQ. Considering industry requirements, this mineral could be used in the ferroalloy industry, without treatments, and in the glass industry for color less packaging or insulation fiber–manufacturing if some purification methods are applied.Fil: Mojica, Marcia. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Recursos Minerales. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Recursos Minerales; ArgentinaFil: Lajoine, María Florencia. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Recursos Minerales. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Recursos Minerales; Argentina. Universidad Tecnológica Nacional. Facultad Regional La Plata. Departamento de Ingeniería Civil. Centro de Investigaciones Viales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Benítez, Manuela. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Recursos Minerales. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Recursos Minerales; ArgentinaFil: Coriale, Nelson. Secretaria de Industria y Mineria. Servicio Geológico Minero Argentino. Subsecretaria de Mineria; ArgentinaFil: Salvioli, Melisa Ariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Recursos Minerales. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Recursos Minerales; ArgentinaFil: Curci, Marcela. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Recursos Minerales. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Recursos Minerales; ArgentinaFil: Lanfranchini, Mabel Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Recursos Minerales. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Recursos Minerales; Argentin