Narcotic Consumption Analysis among Severely Injured and Advanced Aged Trauma Patients.

BACKGROUND: Multimodal pain management has been shown to be effective in treating pain in acutely injured trauma patients. Our community-based, level 1 trauma center previously published in 2022 the efficacy of implementing multimodal pain control (MMPC) protocol in our inpatient trauma population which decreased the use of opioids while maintaining similar pain control. The MMPC group had a trend toward higher age and was significantly less injured. We hypothesize MMPC will reduce opioid consumption in both the advanced aged and more severely injured trauma populations while still providing adequate pain control. METHODS: Defined by the year of admission, MMPC and physician managed pain control (PMPC) were compared in both advanced age groups and between the severely injured groups. The advanced age group included patients ≥55 years old. The severely injured group included ≥18 years old with ≥15 ISS. Primary outcomes were total opioid utilization per day, calculated in morphine milliequivalents (MME), and median daily pain scores. RESULTS: For the severely injured population, the MMPC group showed a 3-fold decrease in opioid use (30 MME/d vs 90.3 MME/d, P < .001) and lower pain scores (5/10 vs 6/10, P < .001) than the PMPC group. In the advance age group, there was no significant difference between MMPC and PMPC groups in opioid use (P = .974) or pain scores (P = .553). CONCLUSION: MMPC effectively reduces opioid consumption in a severely injured patient population while simultaneously improving pain control. Advanced age trauma patients can require complex pain management solutions and future research to determine their needs is recommended.

Crowdsourcing triggers rapid, reliable earthquake locations.

In many cases, it takes several minutes after an earthquake to publish online a seismic location with confidence. Via monitoring for specific types of increased website, app, or Twitter usage, crowdsourced detection of seismic activity can be used to "seed" the search in the seismic data for an earthquake and reduce the risk of false detections, thereby accelerating the publication of locations for felt earthquakes. We demonstrate that this low-cost approach can work at the global scale to produce reliable and rapid results. The system was retroactively tested on a set of real crowdsourced detections of earthquakes made during 2016 and 2017, with 50% of successful locations found within 103 s, 76 s faster than GEOFON and 271 s faster than the European-Mediterranean Seismological Centre's publication times, and 90% of successful locations found within 54 km of the final accepted epicenter.

Extremely sub-wavelength THz metal-dielectric wire microcavities.

We demonstrate minimal volume wire THz metal-dielectric micro-cavities, in which all but one dimension have been reduced to highly sub-wavelength values. The smallest cavity features an effective volume of 0.4 µm(3), which is ~5.10(-7) times the volume defined by the resonant vacuum wavelength (λ = 94 µm) to the cube. When combined with a doped multi-quantum well structure, such micro-cavities enter the ultra-strong light matter coupling regime, even if the total number of electrons participating to the coupling is only in the order of 10(4), thus much less than in previous studies.

Monolithically integrated heterodyne optical phase-lock loop with RF XOR phase detector.

We present results for an heterodyne optical phase-lock loop (OPLL), monolithically integrated on InP with external phase detector and loop filter, which phase locks the integrated laser to an external source, for offset frequencies tuneable between 0.6 GHz and 6.1 GHz. The integrated semiconductor laser emits at 1553 nm with 1.1 MHz linewidth, while the external laser has a linewidth less than 150 kHz. To achieve high quality phase locking with lasers of these linewidths, the loop delay has been made less than 1.8 ns. Monolithic integration reduces the optical path delay between the laser and photodiode to less than 20 ps. The electronic part of the OPLL was implemented using a custom-designed feedback circuit with a propagation delay of ~1 ns and an open-loop bandwidth greater than 1 GHz. The heterodyne signal between the locked slave laser and master laser has phase noise below -90 dBc/Hz for frequency offsets greater than 20 kHz and a phase error variance in 10 GHz bandwidth of 0.04 rad2.

Monitoring and feedback of hand hygiene compliance and the impact on facility-acquired methicillin-resistant Staphylococcus aureus.

In 2006, we began monitoring hand hygiene compliance by direct observation. In 2006, with no changes in the methicillin-resistant Staphylococcus aureus (MRSA) control program, a 38% reduction of facility-acquired rates for this organism was realized. These results indicate that focused monitoring of hand hygiene can reduce facility-acquired rates of MRSA.

Analysis of guidelines for basal-bolus insulin dosing: basal insulin, correction factor, and carbohydrate-to-insulin ratio.

OBJECTIVE: To analyze and compare the underlying mathematical models for basal-bolus insulin-dosing guidelines in patients with type 1 diabetes in a retrospective controlled study. METHODS: Algebraic model-development yielded several systems of models with unknown constants, including 3 systems currently in use. These systems were compared for logic and consistency. One of these systems was the accurate insulin management (AIM) system, which we developed in the setting of our large endocrine practice. Our database consisted of retrospective clinical records for a 7-month period. During this time, correction factor (CF), carbohydrate-to-insulin ratio (CIR), and basal insulin were being adjusted incrementally by titration. The variables studied were height, body weight in pounds (BWlb), CF, CIR, hemoglobin A1c (A1C), basal insulin, and 6-day mean total daily dose of insulin (TDD). The values of the variables used in the study were those determined on arrival of the patients at the office. The last 6 TDDs were entered into the database, and the mean was calculated by formulas within the database. We sorted our database into 2 groups, a well-controlled test group (n = 167; A1C 180 days, no severe hypoglycemic events since the last office visit, and C-peptide level 7% or time on pump <180 days). We obtained one office visit per patient, as follows: from the test group, we chose the visit with the lowest A1C value; from the control group, we chose one visit by use of a computer's random number generator. A significant difference was demonstrated between the correlation constants of the test group versus the control group by performing T tests between the means and F tests between the standard deviations. The least squares estimates of the correlation constants from the test group were recommended in the guidelines, in place of the means, to gain accuracy. By these methods, the guidelines used by the patients with good glycemic control are made available for all patients. RESULTS: With use of the AIM system, the TDD for continuous subcutaneous insulin infusion = 0.24 * BWlb; basal insulin = 0.47 * TDD; CF = 1,700/TDD; and CIR = 2.8 * BWlb/TDD. CONCLUSION: Three mathematical models for CIR are presented, with a rationale for supporting one of them (the AIM model). This model, together with 3 related AIM models, when provided with statistically correlated constants, constitutes the AIM system of guidelines, a consistent and convenient means of estimating insulin-dosing variables for patients with type 1 diabetes.