Self-reported practices and emotions in prescribing opioids for chronic, noncancer pain: A cross-sectional study of German physicians

Background: The pressure on physicians when a patient seeks pain relief and their own desire to be self-effective may lead to the prescription of strong opioids for chronic noncancer pain (CNCP). This study, via physician self-reporting, aims to identify and measure (i) physician adherence to national opioid prescribing guidelines and (ii) physician emotions when a patient seeks a dosage increase of the opioid. Methods: Within a cross-sectional survey—conducted as part of a randomized controlled online intervention trial (ERONA)—600 German physicians were queried on their opioid prescribing behavior (choice and formulation of opioid, indications) for CNCP patients and their emotions to a case vignette describing a patient seeking an opioid dosage increase without signs of objective deterioration. Results: The prescription of strong opioids in this study was not always in accordance with current guidelines. When presented with a scenario in which a patient sought to have their opioid dose increased, some physicians reported negative feelings, such as either pressure (25%), helplessness (25%), anger (23%) or a combination. The risk of non-guideline-compliant prescribing behavior using the example of ultrafast-acting fentanyl for CNCP was increased when negative emotions were present (OR: 1.7; 95%-CI: 1.2–2.6; p = 0.007) or when sublingual buprenorphine was prescribed (OR: 15.4; 95%-CI: 10.1–23.3; p < 0.001). Conclusions: Physicians’ emotional self-awareness represents the first step to identify such direct reactions to patient requests and to ensure a responsible, guideline-based opioid prescription approach for the long-term well-being of the patient

Elastic Scattering and Total Reaction Cross Section for the 6He + 27Al System

The elastic scattering of the radioactive halo nucleus 6He on 27Al target was measured at four energies close to the Coulomb barrier using the RIBRAS (Radioactive Ion Beams in Brazil) facility. The Sao Paulo Potential(SPP) was used and its diffuseness and imaginary strength were adjusted to fit the elastic scattering angular distributions. Reaction cross-sections were extracted from the optical model fits. The reduced reaction cross-sections of 6He on 27Al are similar to those for stable, weakly bound projectiles as {6,7}Li, 9Be and larger than stable, tightly bound projectile as 16O on 27Al.Comment: 7 pages, 1 table, 3 figure

Pre-germination treatments and storage of cassava seeds and their correlation with emergence of seedlings.

Apesar da propagação de mandioca ser efetuada vegetativamente para fins comerciais, a maioria dos acessos mantém ativo o sistema de propagação sexual, o que é fundamental para programas de melhoramento genético. Entretanto, as sementes de mandioca apresentam germinação baixa e desuniforme. Considerando este fato, o objetivo deste trabalho foi avaliar a eficiência do armazenamento, e de diferentes tratamentos pré-germinativos, na emergência de plântulas de mandioca. Para isso, foi conduzido um experimento com sementes originadas da polinização aberta entre plantas de quatro variedades de mandioca de mesa, nas quais foram testados 10 tratamentos pré-germinativos, mais a testemunha. A viabilidade das sementes submetidas aos tratamentos foi avaliada pelo teste do tetrazólio e a avaliação da emergência das plântulas foi realizada através da contagem diária do número de plântulas emersas. Os dados observados foram expressos em porcentagem de emergência, índice de velocidade de emergência e tempo médio de emergência das plântulas. Pelos resultados obtidos, pode-se concluir que o armazenamento, a 4 °C, durante um ano, aumenta a porcentagem de emergência das sementes e favorece a velocidade de emergência de plântulas; e que o calor seco (60 ºC), durante sete e 14 dias, também favorece a velocidade de emergência das plântulas

Engineering the Redox Potential over a Wide Range within a New Class of FeS Proteins

Abstract: MitoNEET is a newly discovered mitochondrial protein and a target of the TZD class of antidiabetes drugs. MitoNEET is homodimeric with each protomer binding a [2Fe-2S] center through a rare 3-Cys and 1-His coordination geometry. Both the fold and the coordination of the [2Fe-2S] centers suggest that it could have novel properties compared to other known [2Fe-2S] proteins. We tested the robustness of mitoNEET to mutation and the range over which the redox potential (EM) could be tuned. We found that the protein could tolerate an array of mutations that modified the EM of the [2Fe-2S] center over a range of ∼700 mV, which is the largest EM range engineered in an FeS protein and, importantly, spans the cellular redox range (+200 to-300 mV). These properties make mitoNEET potentially useful for both physiological studies and industrial applications as a stable, water-soluble, redox agent

Is Excess Calcium Harmful to Health?

Most current guidelines recommend that older adults and the elderly strive for a total calcium intake (diet and supplements) of 1,000 to 1,300 mg/day to prevent osteoporosis and fractures. Traditionally, calcium supplements have been considered safe, effective and well tolerated, but their safety has recently been questioned due to potential adverse effects on vascular disease which may increase mortality. For example, the findings from a meta-analysis of randomized controlled trials (currently published in abstract form only) revealed that the use of calcium supplements was associated with an ~30% increased risk of myocardial infarction. If high levels of calcium are harmful to health, this may alter current public health recommendations with regard to the use of calcium supplements for preventing osteoporosis. In this review, we provide an overview of the latest information from human observational and prospective studies, randomized controlled trials and meta-analyses related to the effects of calcium supplementation on vascular disease and related risk factors, including blood pressure, lipid and lipoprotein levels and vascular calcification

Prevalence, Features and Risk Factors for Malaria Co-Infections amongst Visceral Leishmaniasis Patients from Amudat Hospital, Uganda

Visceral leishmaniasis (VL) and malaria are two major parasitic diseases sharing a similar demographic and geographical distribution. In areas where both diseases are endemic, such as Sudan, Uganda, India and Bangladesh, co-infection cases have been reported, but features and risk factors associated with these co-morbidities remain poorly characterized. In the present study, routinely collected data of VL patients admitted to Amudat Hospital, Uganda, were used to investigate the magnitude of VL-malaria co-infections and identify possible risk factors. Nearly 20% of the patients included in this study were found to be co-infected with VL and malaria, indicating that this is a common condition among VL patients living in malaria endemic areas. Young age (≤9 years) was identified as an important risk factor for contracting the VL-malaria co-infection, while being anemic or carrying a skin infection appeared to negatively correlate with the co-morbidity. Co-infected patients presented with slightly more severe symptoms compared to mono-infected patients, but had a similar prognosis, possibly due to early diagnosis of malaria as a result of systematic testing. In conclusion, these results emphasize the importance of performing malaria screening amongst VL patients living in malaria-endemic areas and suggest that close monitoring of co-infected patients should be implemented