Analysis of Opioid Prescription Patterns and Postoperative Opioid Use in Opioid-Naïve Patients Undergoing Elective Lumbar Spine Surgery

Title: Analysis of Opioid Prescription Patterns and Postoperative Opioid Use in Opioid-Naïve Patients Undergoing Elective Lumbar Spine Surgery Background: Post-operative opioid prescribing patterns after elective spine surgery is a growing topic of concern, as over-prescribing can lead to potential medication dependence, while under-prescribing can lead to inadequate pain management. Objective: The primary objective was to develop prescribing guidelines based upon the amount of opioids used in the first 2 weeks after lumbar spine surgery by 80% of patients. Methods: Utilizing a prospective study design, opioid-naïve patients undergoing elective lumbar spine surgery at our institution were identified each week and preoperatively consented for study participation. Opioid naivete was defined as lack of opioid use at least 1 month prior to the scheduled surgical procedure. At 2 weeks postoperatively, enrolled patients completed a telephone survey questionnaire, which assessed remaining opioid prescription pill count, need for medication refill, and subjective patient satisfaction with opioid dosing. Subsequently, patient charts were retrospectively reviewed for patient demographic and medical co-morbidity data. Univariate two group comparisons were performed using t-tests for continuous variables, and using chi-square, or Fisher’s tests if cell counts are \u3c5 for categorical variables. We then looked at the distribution of MMEs in each cohort in order to determine the opioid needs of 80% of the patient population. Results: A total of 53 opioid-naïve spine surgery patients were included for analysis, of which 23 underwent fusion surgery and 30 underwent non-fusion surgery. Baseline demographics and co-morbidities did not significantly vary between groups. For the fusion group, analysis revealed that an MME of 90 would meet the opioid requirements for 80% of patients. In this group, 60% of fusion patients were under-prescribed opioids, while 27% of patients were over-prescribed. For the non-fusion group, an MME of 45 was determined to meet the opioid requirements of 80% of patients. In this group, 61% of non-fusion patients were overprescribed opioids, while 22% were under prescribed. Conclusions: Amongst opioid-naïve patients who underwent elective lumber spine surgery, patients in the lumbar fusion group were generally under-prescribed postoperative opioids, while patients in the non-fusion groups were over-prescribed. This discrepancy suggests that spine surgeons must account for the procedure type (i.e., fusion vs non-fusion) when prescribing opiates postoperatively in opioid-naïve patients, given patients undergoing lumbar fusion may require a larger MME than non-fusion patients. Keywords: opioid-naïve; lumbar spine surgery; fusion; postoperative opioid use; MM

The Joys of Cooking When You’re a Depressed and Anxious Student

En el presente artículo se pretende mostrar cómo las transformaciones del psiquismo humano, a partir del carácter cultural de las producciones y prácticas del hombre, permiten retomar el tema de la subjetividad como nivel cualitativo distintivo de la especie humana. La subjetividad, entendida en la perspectiva aquí defendida, es un proceso inherente al funcionamiento cultural del hombre y al mundo social generado por sus producciones culturales. Estas consideraciones pretenden responder a la exclusión de la subjetividad por el post-estructuralismo y el neo-pragmatismo, apoyada en la idea de que se trababa de una noción que cargaba con las limitaciones del pensamiento moderno. Frente a esta postura, se argumenta que ninguna de estas corrientes de pensamiento tuvo una conciencia teórica sobre la subjetividad, un concepto que, de hecho, va en dirección opuesta a los principios fundamentales que sustentaron la modernidad tardía, apoyada en la idea de ciencia objetiva y en una representación racional del hombre

Citizen Science Study of Overflight Noise from New and Old Generation Aircraft at London City Airport

This study employs a citizen science methodology to compare the overflight noise of the Embraer E190-E2 with the older Embraer E190 aircraft at London City Airport. The study assesses whether new generation aircraft are quieter in a real-world overflight scenario away from the immediate take-off and landing area. The study uses six monitoring sites, which are an average of 9km from the airport runway and underneath the easterly wind arrivals flight path. The data was gathered using the Explane smartphone app that has a 2dB margin of error. Results from the study indicate a modest 1.7dB noise reduction in new aircraft, with instances of newer models being louder in certain locations and some of the loudest overall. This raises doubts whether a shift towards the new aircraft would create any meaningful reduction in aircraft noise for the communities overflown at London City Airport. It also raises questions about the airport expansion noise models, which are premised on the assumption that the new generation aircraft are significantly quieter. This study argues that airport stakeholders bear the obligation of conveying public environmental information with greater precision and nuance, both in terms of what is established and what remains uncertain concerning noise. They should avoid universalising and potentially misleading phrases like ‘cleaner, quieter new generation aircraft.’ The study suggests a need for a larger follow-up study of real-life noise monitoring at London City Airport using formal and citizen science methods to foster transparency and trust in airport management and policymaking

A question of dialogue? Reflections on how citizen science can enhance communication between science and society

Citizen science is a transdisciplinary approach that responds to the current science policy agenda: in terms of supporting open science, and by using a range of science communication instruments. In particular, it opens up scientific research processes by involving citizens at different phases; this also creates a range of opportunities for science communication to happen This article explores methodological and practical characteristics of citizen science as a form of science communication by examining three case studies that took different approaches to citizens' participation in science. Through these, it becomes clear that communication in citizen science is ‘÷always’ science communication and an essential part of “doing science”

Diversity of Antibiotic-Active Bacteria Associated with the Brown Alga Laminaria saccharina from the Baltic Sea

Bacteria associated with the marine macroalga Laminaria saccharina, collected from the Kiel Fjord (Baltic Sea, Germany), were isolated and tested for antimicrobial activity. From a total of 210 isolates, 103 strains inhibited the growth of at least one microorganism from the test panel including Gram-negative and Gram-positive bacteria as well as a yeast. Most common profiles were the inhibition of Bacillus subtilis only (30%), B. subtilis and Staphylococcus lentus (25%), and B. subtilis, S. lentus, and Candida albicans (11%). In summary, the antibiotic-active isolates covered 15 different activity patterns suggesting various modes of action. On the basis of 16S rRNA gene sequence similarities >99%, 45 phylotypes were defined, which were classified into 21 genera belonging to Alphaproteobacteria, Betaproteobacteria, Gammaproteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria. Phylogenetic analysis of 16S rRNA gene sequences revealed that four isolates possibly represent novel species or even genera. In conclusion, L. saccharina represents a promising source for the isolation of new bacterial taxa and antimicrobially active bacteria

26th Annual Computational Neuroscience Meeting (CNS*2017): Part 3 - Meeting Abstracts - Antwerp, Belgium. 15–20 July 2017

This work was produced as part of the activities of FAPESP Research,\ud Disseminations and Innovation Center for Neuromathematics (grant\ud 2013/07699-0, S. Paulo Research Foundation). NLK is supported by a\ud FAPESP postdoctoral fellowship (grant 2016/03855-5). ACR is partially\ud supported by a CNPq fellowship (grant 306251/2014-0)