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Neil Johnson is a professor of physics at GW and heads up a new initiative in Complexity and Data Science which combines cross-disciplinary fundamental research with data science to attack complex real-world problems. His research interests lie in the broad area of Complex Systems and ‘many-body’ out-of-equilibrium systems of collections of objects, ranging from crowds of

One of aims of this presentation is to assist readers to review the technology data generally described as "pathological science", or "controversial" by comparing mainstream version of data, and "discredited" version of data. With this...

The EESystem generates bio-active energy fields which can boost immunity, relieve pain, detoxify the body, elevate moods, and enhance energy.

Between 75-100 Liberty University forensic science, nursing, criminal justice, and biomedical students joined Saturday morning at the Liberty Indoor Track & Field Complex for the fifth annual bioterrorism simulation, a unique, two-hour instructional event where students learned about emergency first...

With the ever increased security throughout the world’s countries, terrorists have begun to find new ways to inflict fear upon the masses. One such...

The 2001 anthrax bioterrorism attacks demonstrated vulnerability for future similar attacks. This article describes mechanisms that can be used to prepare the medical community and healthcare facilities for the diagnosis and management of a subsequent bioterrorism attack should such an event occur …

Objective Multimodal analgesia pathways have been shown to reduce opioid use and side effects in surgical patients. A quality improvement initiative was implemented to increase the use of multimodal analgesia in adult patients presenting for general anaesthesia at an academic tertiary care centre. The aim of this study was to increase adoption of a perioperative multimodal analgesia protocol across a broad population of surgical patients. The use of multimodal analgesia was tracked as a process metric. Our primary outcome was opioid use normalised to oral morphine equivalents (OME) intraoperatively, in the postanaesthesia care unit (PACU), and 48 hours postoperatively. Pain scores and use of antiemetics were measured as balancing metrics. Methods We conducted a quality improvement study of a multimodal analgesia protocol implemented for adult (≥18 and≤70) non-transplant patients undergoing general anaesthesia (≥180 min). Components of multimodal analgesia were defined as (1) preoperative analgesic medication (acetaminophen, celecoxib, diclofenac, gabapentin), (2) regional anaesthesia (peripheral nerve block or catheter, epidural catheter or spinal) or (3) intraoperative analgesic medication (ketamine, ketorolac, lidocaine infusion, magnesium, acetaminophen, dexamethasone ≥8 mg, dexmedetomidine). We compared opioid use, pain scores and antiemetic use for patients 1 year before (baseline group—1 July 2018 to 30 June 2019) and 1 year after (implementation group—1 July 2019 to 30 June 2020) project implementation. Results Use of multimodal analgesia improved from 53.9% in the baseline group to 67.5% in the implementation group (p

Opioid misuse concerns have led trauma practitioners to recommend multimodal pain control. A trauma surgeon talks about pain management revision and success requisites, the opioid epidemic, and current and future pain management.

Driven by illicit fentanyl, opioid related deaths have reached the highest level in 2020. Currently, an opioid overdose is resuscitated by the use of naloxone, which competitively binds and antagonizes the μ-opioid receptor (mOR). Thus, knowledge of the residence times of opioids at mOR and the unbinding mechanisms is valuable for assessing the effectiveness of naloxone. In the present study, we calculate the fentanyl-mOR dissociation time and elucidate the mechanism by applying an enhanced sampling molecular dynamics (MD) technique. Two sets of metadynamics simulations with different initial structures were performed while accounting for the protonation state of the conserved H2976.52, which has been suggested to modulate the ligand-mOR affinity and binding mode. Surprisingly, with the Nδ-protonated H2976.52, fentanyl can descend as much as 10 Å below the level of the conserved D1473.32 before escaping the receptor and has a calculated residence time τ of 38 s. In contrast, with the Nϵ- and doubly protonated H2976.52, the calculated τ are 2.6 and 0.9 s, respectively. Analysis suggests that formation of the piperidine–Hid297 hydrogen bond strengthens the hydrophobic contacts with the transmembrane helix (TM) 6, allowing fentanyl to explore a deep pocket. Considering the experimental τ of ∼4 min for fentanyl and the role of TM6 in mOR activation, the deep insertion mechanism may be biologically relevant. The work paves the way for large-scale computational predictions of opioid dissociation rates to inform evaluation of strategies for opioid overdose reversal. The profound role of the histidine protonation state found here may shift the paradigm in computational studies of ligand–receptor kinetics.

Definition and History of Social Injustice in America

Since 1986, PRMS has provided a specialized psychiatric professional liability insurance program with tailored risk management and defense strategies.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (), a manager of medical professional liability ...

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