Application of risk assessment tools to predict opioid usage after shoulder surgery.

Background: Currently 128 people die daily from opioid-related overdoses in the United States. This burden has instigated a search for viable means to guide postoperative prescription decision-making. The Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patient with Pain (SOAPP) are validated risk assessment tools to predict opioid usage in high-risk populations. The purpose of this study was to evaluate the accuracy of these opioid risk assessments and pain intensity scores, including the Patient-Reported Outcomes Measurement Information System (PROMIS), to predict postoperative opioid use and dependence in shoulder surgery. Methods: A retrospective review of 81 patients who underwent shoulder surgery and completed 3 preoperative risk and pain assessments within a single hospital system from 2018 to 2020 was performed. Demographic variables and ORT-O, SOAPP-R (the revised version of the SOAPP assessment), and PROMIS 3a scores were recorded from preoperative assessments. Opioid prescriptions were recorded from Electronic-Florida Online Reporting of Controlled Substances Evaluation. Dependence was defined as opioid prescriptions at or greater than 3 months after surgery. Risk assessment scores were compared and tested against postoperative opioid prescriptions using statistical analyses and logistic regression modeling. Results: In the cohort, there were 36 female and 45 male patients with an average age of 64.5 years and body mass index of 28.0. Preoperatively, the average pain score was 6.2, and 7.8% of patients reported prolonged preoperative narcotics use. The average ORT-O score was 3.0, with 35.8% of patients defined as either medium or high risk, and the average PROMIS pain intensity preoperatively was 10.8. Neither the ORT-O nor the PROMIS pain score were good predictors of postoperative opioid dependence (area under curve = 0.39 and 0.43, respectively). The SOAPP-R performed slightly better (area under curve = 0.70) and was the only assessment with significantly different mean scores between patients with postoperative opioid dependence and those without (33.4 and 24.5, respectively, P = .049) and a moderate correlation to postoperative total morphine equivalents (R = 0.46, P = .007). Conclusion: With recent focus on preoperative risk assessments to predict postoperative opioid use and dependence, it is important to understand how well these tools work when applied to orthopedic patients. While the ORT may be helpful in other fields, it does not seem to be a strong predictor of postoperative opioid use or dependence in patients undergoing various types of shoulder surgery. Future studies are needed to explore the utility of the SOAPP-R in a larger sample and identify tools applicable to the orthopedic population to assist surgeons in screening at-risk patients.

Analysis and Simulation of Polymer Injectivity Test in a High Temperature High Salinity Carbonate Reservoir.

Polymer flooding has gained much interest within the oil industry in the past few decades as one of the most successful chemical enhanced oil recovery (CEOR) methods. The injectivity of polymer solutions in porous media is a key factor in polymer flooding projects. The main challenge that faces prediction of polymer injectivity in field applications is the inherent non-Newtonian behavior of polymer solutions. Polymer in situ rheology in porous media may exhibit complex behavior that encompasses shear thickening at high flow rates in addition to the typical shear thinning at low rates. This shear-dependent behavior is usually measured in lab core flood experiments. However, data from field applications are usually limited to the well bottom-hole pressure (BHP) as the sole source of information. In this paper, we analyze BHP data from field polymer injectivity test conducted in a Middle Eastern heterogeneous carbonate reservoir characterized by high-temperature and high-salinity (HTHS) conditions. The analysis involved incorporating available data to build a single-well model to simulate the injectivity test. Several generic sensitivities were tested to investigate the impact of stepwise variation in injection flow rate and polymer concentration. Polymer injection was reflected in a non-linear increase in pressure with injection, and longer transient behavior toward steady state. The results differ from water injection which have linear pressure response to rate variation, and quick stabilization of pressure after rate change. The best match of the polymer injection was obtained with complex rheology, that means the combined shear thickening at high rate near the well and moving through apparent Newtonian and shear thinning at low rate.

Quality survey and spatiotemporal variations of atrazine and desethylatrazine in drinking water in Quebec, Canada.

The herbicide atrazine remains in use in Canada, the United States, and several other countries, while being banned since 2003 in the European Union. A comprehensive quality survey of atrazine (ATZ) and one of its metabolites, desethylatrazine (DEA), was conducted in 2015-2018 in drinking water available to consumers in Quebec, Canada. Temporal variations of ATZ and DEA were monitored in tap water from the Montreal area for 18 consecutive months (Temporal survey 2015-2016). Within this time window, the sum of ATZ and DEA in tap water samples (n = 450) varied from 40 to 250 ng L-1 (median: 98 ng L-1). ATZ was systematically detected (100%), with a concentration range of 30-195 ng L-1 (median: 49 ng L-1) while DEA was in the range of 10-187 ng L-1 (median: 36 ng L-1). Maximum ATZ concentrations remained about 25× lower than the Canadian drinking water quality guideline (5000 ng L-1), but 48% of the samples were above that of the European Union (100 ng L-1) regarding the sum of ATZ and DEA. Trends of ATZ and DEA in drinking water were also examined across southwestern Quebec (Spatial survey 2017-2018). The sum of the two triazines in this second set of samples varied from below the method detection limit (for 33 out of the 52 surveyed municipalities) to 104 ng L-1. Apart from Montreal, locations in the southern shore of the St. Lawrence showed generally higher levels of atrazine and DEA. The highest concentrations clustered in the Montérégie region, along the St. Lawrence River (e.g., Brossard, Longueuil, Saint-Constant) and/or downstream from agricultural areas. The ATZ concentrations are suggested to have decreased compared to previous surveys, which is consistent with the decrease in the sales of active ingredients in Ontario (upstream sources) and Quebec.

Widespread occurrence and spatial distribution of glyphosate, atrazine, and neonicotinoids pesticides in the St. Lawrence and tributary rivers.

The occurrence and spatial distribution of selected pesticides were investigated along a 200-km reach of the St. Lawrence River (SLR) and tributaries in Quebec, Canada. Surface water samples (n = 68) were collected in the summer 2017 and analyzed for glyphosate, atrazine (ATZ), 8 systemic insecticides (acetamiprid, clothianidin, dinotefuran, fipronil, imidacloprid, nitenpyram, thiacloprid, and thiamethoxam) and some metabolites. Overall, 99% of the surface water samples were positive to at least one of the targeted pesticides. The most recurrent compounds were glyphosate (detection frequency: 84%), ATZ (82%), thiamethoxam (59%), desethylatrazine (DEA: 47%), and clothianidin (46%). Glyphosate displayed variable levels (4-3,000 ng L-1), with higher concentrations in south tributaries (e.g., Nicolet and Yamaska). In positive samples, the sum of ATZ and DEA varied between 5 and 860 ng L-1, and the sum of 6 priority neonicotinoids between 1.5 and 115 ng L-1. From Repentigny to the Sorel Islands, the spatial distribution of pesticides within the St. Lawrence River was governed by the different upstream sources (i.e., Great Lakes vs. Ottawa River) due to the limited mixing of the different water masses. Cross-sectional patterns revealed higher concentrations of glyphosate and neonicotinoids in the north portions of transects, while the middle and south portions showed higher levels of atrazine. In Lake St. Pierre and further downstream, cross-sections revealed higher levels of the targeted pesticides near the southern portions of the SLR. This may be due to the higher contributions from south shore tributaries impacted by major agricultural areas, compared to north shore tributaries with forest land and less cropland use. Surface water samples were compliant with guidelines for the protection of aquatic life (chronic effects) for glyphosate and atrazine. However, 31% of the samples were found to surpass the guideline value of 8.3 ng L-1 for the sum of six priority neonicotinoids.

Evaluation of on-line concentration coupled to liquid chromatography tandem mass spectrometry for the quantification of neonicotinoids and fipronil in surface water and tap water.

A study was initiated to investigate a fast and reliable method for the determination of selected systemic insecticides in water matrixes and to evaluate potential sources of bias in their analysis. Acetamiprid, clothianidin, desnitro-imidacloprid, dinotefuran, fipronil, imidacloprid, nitenpyram, thiacloprid, and thiamethoxam were amenable to analysis via on-line sample enrichment hyphenated to ultra-high-performance liquid chromatography tandem mass spectrometry. The selection of on-line solid-phase extraction parameters was dictated by a multicriterion desirability approach. A 2-mL on-line injection volume with a 1500 µL min-1 loading flow rate met the objectives sought in terms of chromatographic requirements, extraction efficiency, sensitivity, and precision. A total analysis time of 8 min per sample was obtained with method limits of detection in the range of 0.1-5 ng L-1 for the scope of targeted analytes. Automation at the sample concentration step yielded intraday and interday precisions in the range of 1-23 and 2-26%, respectively. Factors that could affect the whole method accuracy were further evaluated in matrix-specific experiments. The impact of the initial filtration step on analyte recovery was evaluated in ultra-pure water, tap water, and surface water. Out of the nine membranes tested, glass fiber filters and polyester filters appeared as the most appropriate materials. Sample storage stability was also investigated across the three matrix types; the targeted analytes displayed suitable stability during 28 days at either 4 °C or - 20 °C, with little deviations (± 10%) with respect to the initial T0 concentration. Method applicability was demonstrated in a range of tap water and surface water samples from the province of Québec, Canada. Results from the present survey indicated a predominance of thiamethoxam (< 0.5-10 and 3-61 ng L-1 in tap water and river water, respectively), clothianidin (< 0.5-6 and 2-88 ng L-1 in tap water and river water, respectively), and imidacloprid (< 0.1-1 and 0.8-38 ng L-1 in tap water and river water, respectively) among the targeted analytes. Graphical abstract ᅟ Development of solid-phase extraction coupled on-line to UHPLC-MS/MS for the rapid screening of systemic insecticides in water.

The influence of pre-fermentative maceration and ageing factors on ester profile and marker determination of Pedro Ximenez sparkling wines.

The influence of pre-fermentative maceration and ageing factors on the ester profiles of Pedro Ximenez sparkling wines was evaluated. The pre-fermentative maceration consisted of the skin-maceration of musts at 10°C for 6h. The sparkling wines were produced following the Champenoise method. Samples were monitored at 3, 6 and 9months of ageing on lees. Sparkling wines with pre-fermentative maceration displayed higher contents of ethyl esters of branched acids and cinnamates. Meanwhile, those without maceration showed higher levels of ethyl esters of fatty acids and higher alcohol acetates. The study of statistical interactions elucidated different hydrolytic kinetics and developments in higher alcohol acetates and ethyl esters of branched acids during ageing. The application of a dual criterion based on univariate (ANOVA) and multivariate analyses (OPLS-DA) allowed us to identify new potential volatile markers related to pre-fermentative maceration and ageing time, reported for the first time in sparkling wines.

Quantitative Profiling of Ester Compounds Using HS-SPME-GC-MS and Chemometrics for Assessing Volatile Markers of the Second Fermentation in Bottle.

A quantitative approach using HS-SPME-GC-MS was performed to investigate the ester changes related to the second fermentation in bottle. The contribution of the type of base wine to the final wine style is detailed. Furthermore, a discriminant model was developed based on ester changes according to the second fermentation (with 100% sensitivity and specificity values). The application of a double-check criteria according to univariate and multivariate analyses allowed the identification of potential volatile markers related to the second fermentation. Some of them presented a synthesis-ratio around 3-fold higher after this period and they are known to play a key role in wine aroma. Up to date, this is the first study reporting the role of esters as markers of the second fermentation. The methodology described in this study confirmed its suitability for the wine aroma field. The results contribute to enhance our understanding of this fermentative step.

Resultados de tratamiento para cáncer infantil en una población de recursos limitados en Bogotá, Colombia / Pediatric cancer results in a population with limited resources in Bogota, Colombia

Introducción. A pesar de los notables progresos en cáncer infantil, más del 60% de los niños afectados en el mundo tienen escaso acceso a tratamientos eficaces. El propósito de este estudio fue evaluar los resultados de tratamiento en una situación de recursos limitados. Métodos. Fue un estudio descriptivo-histórico con componente analítico en 242 menores de 16 años atendidos entre 1990 y 2007 en la Clínica Infantil Colsubsidio de Bogotá, Colombia. Durante tres periodos se introdujeron protocolos internacionales, atención en "hospital de día" para tratamientos de quimioterapia y soporte ambulatorio, con enfermeras entrenadas en oncología, una pediatra oncóloga y un hematólogo con dedicación de 8 horas, el apoyo en hospitalización de médicos pediatras 24 horas y la agilización de trámites administrativos. Se compararon la supervivencia y las fallas de tratamiento. Resultados. Se observó aumento (40.5 a 63%) en la supervivencia (P =0.021) y disminución (22.4 a 8.9%) en la remisión a otros centros (P =0.025); tendencia a la reducción en mortalidad por complicaciones agudas (16.3 a 9.9%) y en frecuencia de rechazo o abandono del tratamiento (5.2 a 3%). La supervivencia libre de eventos para leucemia linfoblástica fue de 65% a 10 años. Conclusiones. El programa mostró resultados alentadores en un contexto de recursos limitados.

Background. Despite remarkable progress achieved for pediatric cancer, >60% of children affected worldwide have little or no access to effective therapy. This study assessed the results of a pediatric cancer program in a limited resources setting. Methods. A historical descriptive study with analytic component was conducted between 1990 and 2007 in 242 children <16 years of age at Clínica Infantil Colsubsidio in Bogotá, Colombia. Measures included international protocol-based therapy, day-hospital system for chemotherapy and blood-cell support provided by trained nurses, pediatric oncologist and hematologist staffed 8-h with 24-h on-site physician coverage, as well as rapid administrative support. Treatment failure rates and survival were compared during the study. Results. An increase (40.5% to 63.3%) in survival (p =0.021) and a reduction in the referral for treatment (22.4% to 8.9%) to other centers (p =0.025) were observed during the study. There were also tendencies towards reduction in mortality due to acute complications (16.3-9.9%) and in frequency of those who refused or abandoned therapy (5.2 to 3%).The 10-year event-free-survival for acute lym-phoblastic leukemia was 65%. Conclusions. The strategy provided encouraging survival outcomes in a limited resources setting.

Consentimiento informado en el menor (II) / Informed consent in the minority of age (II)

No disponible

El atentado terrorista del 11 M: análisis sobre los heridos atendidos en el Hospital Central de la Defensa / The 11 M terrorist attack: analysis of the observed lesions among the injured people assisted in the Central Military Hospital

Objetivo: Describir las lesiones de los heridos atendidos en el Hospital Central de la Defensa como consecuencia del atentado terrorista del 11 M. Método: Estudio descriptivo del tipo de lesiones de los heridos evacuados desde los focos del atentado hasta al Servicio de Urgencias. Se estudiaron los antecedentes demográficos y los relacionados con la hospitalización. Los datos se recogieron a partir de las historias clínicas de los pacientes. Resultados: Se atendieron 51 heridos evacuados en ambulancia desde los lugares del atentado. La llegada de enfermos se produjo a partir de los 50 minutos de producirse el atentado y continuó durante aproximadamente tres horas. Precisaron ingreso hospitalario el 60,78 por ciento de los pacientes atendidos. Las lesiones se caracterizaron por su gran variedad. La afectación de partes blandas, con diferentes grados de complejidad, fue la lesión más habitual y, la asociación a otras como la afectación auditiva fue muy frecuente. Conclusiones: Las lesiones atribuidas a los efectos secundarios y terciarios de la explosión han sido las más frecuentes. El atentado muestra una disparidad muy llamativa entre la mortalidad in situ y la acontecida a nivel hospitalario. La llegada de los heridos al hospital no se realizó en orden a una mayor gravedad de sus lesiones. La realización de una nueva clasificación y estratificación de riesgo en el propio hospital resultó ser una actividad imprescindible. La trascendencia del siniestro hace necesario un estudio profundo que agrupe a las instituciones implicadas en la asistencia de todas las víctimas (AU)

El experimento clínico controlado / Controlled clinical trials

El mejor instrumento disponible para establecer si una nueva intervención en salud produce más beneficios que perjuicios a los sujetos que la reciben en el experimento clínico controlado (también conocido como ensayo clínico). Este diseño permite al investigador observar los resultados de la intervención en un grupo de individuos, y comparar su respuesta con la obtenida en un grupo control tan parecido al primero como sea posible, pero que recibe el tratamiento convencional. Aunque éste principio es relativamente simple, la ejecución de un experimento clínico requiere una cuidadosa planificación, que incluye la definición de la pregunta de investigación, la selección de los sujetos, su asignación a los tratamientos del estudio, la descripción de las intervenciones, la evaluación de las respuestas a los mismos y el análisis de los resultados. En cada uno de éstos pasos existe el riesgo de crear diferencias sistemáticas entre los grupos en aspectos diferentes a las investigaciones que se comparan, que pueden llevar al investigador a conclusiones que no se ajustan a la verdad. Adicionalmente, la inclusión de sujetosw humanos en éstos estudios requiere una muy cuidadosa consideración de aspectos éticos.