Net energy, energy utilization, and nitrogen and energy balance affected by dietary pea supplementation in broilers.

Pea starch consists predominantly of C-type of amylopectin chain which is more resistant to digestive enzymes than A-type of starch thus slowly digested in poultry. It was hypothesized that the presence of slowly digested pea starch in broiler diets will increase net energy and the efficiency of energy utilization in broilers. Two experiments were performed to investigate starch digestibility of pea at different incubation times (in vitro study) and the effect of dietary pea on heat increment and net energy in broilers using an open-circuit respiratory calorimetry system (in vivo study). One-day-old Ross 308 male broilers were fed a common starter crumble from d 1 to 10 and standard grower diets thereafter. At d 21, birds were transferred to the chambers each housing 2 birds. Each treatment was replicated 6 times with 2 identical runs of 3 replicates per treatment. A wheat-soybean meal-based diet was used as a control and the treatment diet contained 500 g of pea/kg pea. In vitro study showed that pellet processing increased (P < 0.001) starch digestibility, particularly at shorter times for wheat and a much larger response for pea. Birds offered the pea-based diet had lower (P = 0.002) feed intake, lower (P = 0.020) body weight gain, but a similar (P > 0.05) FCR compared to those offered the wheat-based diet. Net energy (NE) and apparent metabolizable energy (AME) values were higher in the pea-based diet than in the wheat-based diet (P = 0.037 for NE and P = 0.018 for AME). Heat production, respiratory quotient, heat increment of feed, efficiency of utilization of gross energy for AME, and efficiency of utilization of AME for NE did not differ (P > 0.05) between the 2 treatments. There was no effect (P > 0.05) of pea on the total tract digestibilities of dry matter, crude protein and ash, but the total tract digestibility of starch was higher (P = 0.022) in the pea-based diet compared to the wheat-based diet. This study provides insight into the energy metabolism of broilers offered a pea-based diet and indicates that dietary pea supplementation increases dietary AME and NE but has no effect on heat increment of feed and the efficiency of energy utilization in broilers.

Multimodal Pain Management of Femoral Neck Fractures Treated With Hemiarthroplasty.

The purpose of this study was to evaluate a multimodal pain management program incorporating periarticular injections of liposomal bupivacaine after hemiarthroplasty treatment of femoral neck fractures. This retrospective study selected patients treated with periarticular injections of liposomal bupivacaine within the multimodal pain management program (LBUP) (n = 100) and a control group of patients treated without local infiltration (n = 78). Similar pain control was achieved between both groups from day 1 to day 4 postsurgery (min p = .392). Length of stay was significantly lower for LBUP patients (4.8 days vs. 5.7 days, p = .013), and LBUP patients were significantly more likely to be ambulatory at discharge (82% vs. 69%, p = .013). LBUP patients were also less likely to need the intensive care unit (4% vs. 14%, p = .027). The percentage of patients with at least one opioid-related adverse event was lower in the LBUP group (3% vs. 8%, p = .156) as was the 90-day mortality rate (2% vs. 8%, p = .069), but the differences were not statistically significant. (Journal of Surgical Orthopaedic Advances 28(1):58-62, 2019).

Current Practices for Multimodal Pain Management Using Liposomal Bupivacaine in Extracapsular and Intracapsular Hip Fracture Surgery: Expert Panel Opinion.

BACKGROUND: Liposomal bupivacaine (LB) has demonstrated efficacy across a range of surgical settings, including shoulder, knee, and hip surgery. However, data are limited on the use of LB as part of a multimodal pain management approach in hip fracture surgery. METHODS: On April 1, 2017, 4 orthopaedic surgeons and 3 anesthesiologists convened to discuss current practices and develop a consensus statement related to local infiltration analgesia with LB for hip fracture surgical procedures within the context of a multimodal opioid-sparing pain management approach. Separate workshops addressed intracapsular and extracapsular hip fracture surgery. RESULTS: Multimodal strategies before, during, and after hip fracture surgery are paramount to optimizing pain control and minimizing opioid requirements. LB infiltration should occur intraoperatively near the time of closing the incision. For both intracapsular and extracapsular procedures, oral or intravenous acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID) of choice, and tramadol should be given preoperatively. Presurgical fascia iliaca block with bupivacaine HCl may help bridge the period before LB takes effect. After both procedures, patients should receive 1 dose of intravenous acetaminophen, an NSAID, and opioid rescue medication as needed, starting with tramadol. Postoperative NSAIDs may help minimize opioid use. Patient and provider education are integral to managing patient expectations and alleviating concerns about pain and opioid use. Standardized, validated, and appropriately timed pain assessments are also necessary to optimize postsurgical pain management. CONCLUSIONS: These consensus recommendations regarding multimodal pain management protocols incorporating local infiltration analgesia with LB for extracapsular and intracapsular hip fracture procedures serve as a basis for additional research. LEVEL OF EVIDENCE: Level V.

Infiltration Techniques for Local Infiltration Analgesia With Liposomal Bupivacaine in Extracapsular and Intracapsular Hip Fracture Surgery: Expert Panel Opinion.

BACKGROUND: Liposomal bupivacaine (LB) has demonstrated efficacy in improving pain scores and reducing opioid consumption across a variety of surgical settings, including orthopaedic surgery. However, meticulous infiltration techniques combined with a multimodal approach are important to optimizing outcomes. METHODS: A panel of 4 orthopaedic surgeons and 3 anesthesiologists convened on April 1, 2017, to discuss current practices and develop a consensus statement regarding local infiltration analgesia with LB for extracapsular and intracapsular hip fracture surgery, including LB infiltration techniques. RESULTS: Optimizing surgical outcomes with LB in hip fracture surgery requires an understanding of the neuroanatomy of the surgical site and the pharmacology of the drug. Meticulous infiltration technique is critical to achieve optimal results with LB given its viscosity and reduced diffusion compared with bupivacaine HCl. For extracapsular procedures, a total injection volume of 120 mL is recommended, whereas intracapsular procedures typically require a lower volume (∼80 mL). In both cases, infiltration is best achieved using a 22-gauge needle and applying a tracking and/or fanning technique. To ensure optimal placement, LB should be infiltrated using multiple, small-volume (1- to 5-mL) injections spaced at 1.0-cm intervals. CONCLUSIONS: These consensus recommendations regarding LB infiltration techniques can serve as a resource for designing clinical studies to evaluate outcomes using periarticular infiltration of LB in extracapsular and intracapsular hip fracture surgery as part of a multimodal pain management approach. LEVEL OF EVIDENCE: Level V.

Local infiltration of liposome bupivacaine in orthopedic trauma patients: case-based reviews.

Orthopedic trauma surgery is often associated with considerable postoperative pain, which can result in a cascade of direct and indirect clinical consequences. Patients undergoing orthopedic trauma surgery are at risk for the development of chronic postsurgical pain, which may persist for 2 years or longer. Effective approaches to reducing postoperative pain in orthopedic trauma surgery patients include the use of minimally invasive procedures and multimodal analgesia. Infiltration of the surgical site with EXPAREL® (bupivacaine liposome injectable suspension), an extended-release local anesthetic, represents an advance in the multimodal management of postoperative pain. As part of a multimodal regimen, EXPAREL® has been shown to provide effective, safe, and efficient analgesia across a range of surgical procedures. Two cases that illustrate the use of EXPAREL® in orthopedic trauma are described. The first case involves repair of a subtrochanteric nonunion in a 63-year-old woman with a history of bisphosphonate use and prior treatment with a cephalomedullary nail. The second case involves a young woman undergoing outpatient surgery for repair of a fractured clavicle. Both patients experienced good control of postsurgical pain, supporting the clinical utility of EXPAREL® in orthopedic trauma surgery.

A new species of Hibiscadelphus Rock (Malvaceae, Hibisceae) from Maui, Hawaiian Islands.

Hibiscadelphus stellatus H. Oppenheimer, Bustamente, & Perlman, sp. nov., a new, narrowly endemic species from West Maui, Hawaiian Islands is described, illustrated and its affinities and conservation status are discussed. It is currently known from three populations totaling 99 plants in Kaua`ula valley on leeward western Maui. It differs from H. wilderianus, its nearest congener, in its denser white or tan stellate pubescence on most parts; larger externally purple colored corollas that are 5-6.5 cm long; linear-subulate to lanceolate, acute to acuminate involucral bracts; globose-cuboid to ovoid capsules; and endocarp with scattered hairs.

Evidence-based HIV/STD prevention intervention for black men who have sex with men.

This report summarizes published findings of a community-based organization in New York City that evaluated and demonstrated the efficacy of the Many Men, Many Voices (3MV) human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevention intervention in reducing sexual risk behaviors and increasing protective behaviors among black men who have sex with men (MSM). The intervention addressed social determinants of health (e.g., stigma, discrimination, and homophobia) that can influence the health and well-being of black MSM at high risk for HIV infection. This report also highlights efforts by CDC to disseminate this evidence-based behavioral intervention throughout the United States. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion to provide an example of a program that might be effective for reducing HIV infection- and STD-related disparities in the United States. 3MV uses small group education and interaction to increase knowledge and change attitudes and behaviors related to HIV/STD risk among black MSM. Since its dissemination by CDC in 2004, 3MV has been used in many settings, including health department- and community-based organization programs. The 3MV intervention is an important component of a comprehensive HIV and STD prevention portfolio for at-risk black MSM. As CDC continues to support HIV prevention programming consistent with the National HIV/AIDS Strategy and its high-impact HIV prevention approach, 3MV will remain an important tool for addressing the needs of black MSM at high risk for HIV infection and other STDs.

Distal biceps tendon insertion: an anatomic study.

Knowledge of the exact location of the distal biceps brachii insertion is crucial when performing tendon reconstruction or repair. To quantitatively describe the morphology of the distal biceps brachii insertion, 20 cadaveric arms were examined. Linear and angular measurements, including the footprint dimensions and shape, radial tuberosity dimensions and irregularities, and the rotational position of the tuberosity and footprint, were obtained. The axial and transverse dimensions of the radial tuberosity and distal biceps tendon footprint measured 24.2 x 12 mm and 18.7 x 3.7 mm, respectively. The insertion footprint is on the posterior/ulnar aspect of the radial tuberosity centered at approximately 30 degrees anterior to the lateral/coronal plane with the forearm fully supinated. This explains why any preoperative limitation in supination may make an anatomic repair difficult through a single anterior incision. To our knowledge, this is the first study to quantitatively describe the angular location of the radial tuberosity and the relationship of the distal biceps tendon on the tuberosity.

Detection of sexual orientation by heterosexuals and homosexuals.

The purpose of this study was to determine if sexual orientation can be correctly identified under controlled conditions. A series of 24 brief videotaped interviews with homosexual and heterosexual men and women were presented to a sample of 143 subject raters divided into four sexual preference and gender groups. None of the groups were able to exceed levels of correct detection. Approximately 20% of the total subject pool did exceed chance levels. There were significantly more women than men in this sub-sample and homosexual women were represented disproportionately. Although there were some differences in the types of behavioral cues used by the different sexual preference groups to make their judgments, with the possible exception of homosexual women, these cues were unrelated to accurate identification of sexual orientation. The relatively better performance of female raters is discussed in terms of differences in the socialization process of men and women.