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

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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 ...

Finnish record label founded in 1990 by Riku Pääkkönen. Initially a mailorder/distribution company for rock and metal releases, but soon started to release albums of Finnish metal bands. In March 2002 Spinefarm became part of Universal Music, when Universal Music Oy became the majority shareholder of Spin-Farm Oy (the record company that runs...

Join us as we examine the need and potential for the exploration of primary metals in Europe.

SSPC crystal competition – Dr Sarah Hayes, SSPC at the University of Limerick with previous winners. Picture: Alan Place SSPC are running a competition challenging young crystal growers Science Foundation Ireland research centres SSPC, the SFI Research Centre for Pharmaceuticals, and, iCRAG, the SFI Research Centre for Applied Geosciences have announced the start of the […]

View Jennifer Craig's business profile as Director of Social Services at Falls Village Retirement Cmnty. Find Jennifer's email address, mobile number, work history, and more.

How can we source and use Earth resources in an ethical and responsible way? And how can we bring different actors and communities together to achieve sustainable resource development? These are just some of the questions that early career researchers from around the world came together to discuss during the inaugural Researching Social Theories, Resources, and the Environment International Summer School, held at the University College Dublin last month. In this blog post, Anthea Lacchia, a postdoctoral researcher at the Irish Centre for Research in Applied Geosciences, and Jen Roberts, a Chancellor’s Fellow in Energy at the University of Strathclyde, share their experience reporting on this summer school. On the first week of July 2019, we were lucky enough to be part of a very special gathering of geoscientists and social scientists from developed and developing countries at University College Dublin (UCD), Ireland. The occasion that brought them all together was the inaugural Researching Social Theories, Resources, and Environment (ReSToRE) International Summer School. The goal of the ReSToRE summer school was to enable critical cross-disciplinary discussions around the sustainable sourcing and use of Earth resources now and in the future. Big topic, right? And certainly one that can only be tackled by bringing together different perspectives, as became apparent during the week. Organised by iCRAG, the Irish Centre for Research in Applied Geosciences, the summer school included 42 early career researchers and recent graduates from 28 nations including 18 developing countries. “Moving forward for sustainable development is very complicated,” said Murray Hitzman, Director of iCRAG. “Not only are there technical challenges in terms of Earth resources and energy, but in terms of how people actually perceive both sustainable development and those challenges is even more critical.” “This summer school is trying to help with this not just in one society, but in multiple societies, and to get those societies to understand one another as well, which is also a huge challenge,” he noted. The summer school succeeded in creating a stimulating setting for interdisciplinary collaboration, knowledge sharing and network-building. During the week, participants discussed emerging themes pertinent to the future of resourcing and consumption of Earth materials, such as: what drives societal attitudes toward the extraction industry? How can communities have their say in if and how resources near to them are developed? What are the barriers to a circular economy in the resources sector? How can Earth materials be resources in an ethical and responsible way? Participants took the lead in deliberating these big questions. They were aided by guidance from expert mentors, as well as plenary talks and discussions. The conversations naturally spilled from the workshops into the social events, which included a fieldtrip to Glendalough, Co. Wicklow, Ireland, the site of an ancient lead, zinc and silver mine, and now a spectacular glacial valley. And Summer put on a fine performance for the week, allowing the participants to move outside and seek inspiration amongst the fresh air, daisies and curious ducks. ReSToRE painting by summer school participant and artist, Meenakshi Poti (joint PhD student at Université Libre de Bruxelles and Vrije Universiteit Brussel, Belgium). “Deposits of the metals that we need are irregularly distributed across the globe, and their value must be assessed with respect to sustainable development, alleviation of poverty and empowering of communities,” said International Union of Geological Sciences (IUGS) Councillor, Edmund Nickless, at the opening session of the summer school. “This course is asking the right questions at the right time and the mix of social scientists and geoscientists and environmental scientists together is a triangle we really need,” added Ozlem Adiyaman Lopes from UNESCO’s Earth and Ecological Sciences division, who was able to join the summer school for several days. Amongst participants and expert mentors 33 different nationalities were represented, including from Afghanistan, Australia, Bangladesh, Belgium, Botswana, Canada, Chile, Colombia, Congo (DR), Croatia, Ethiopia, Finland, Germany, Hungary, India, Ireland, Italy, Kenya, Lithuania, Mozambique, Namibia, Netherlands, Papua New Guinea, Russia, Sierra Leone, South Africa, Sweden, Switzerland, Tanzania, Turkey, UK, USA, and Zimbabwe. What an incredible forum! Some reflections on the way ahead Some key themes emerged from the conversations amongst the participants, expert mentors and organisers during the week. Firstly, the different actors necessary for resourcing a sustainable future cannot be considered in isolation. Consumer demand, business practices, environmental and societal impacts, community involvement in decision-making and development are all intrinsically interlinked in a non-linear chain which interweaves resource supply use and reuse. Future resource development in line with global sustainability goals will require interplay between the technical and non-technical worlds, bridging policy, industry, practitioners and academia, and uniting geoscience and engineering, and social and political science, as well as local communities. Summer school participants admiring the Irish landscape during the ReSToRE fieldtrip, Sally Gap, Co. Wicklow. The circular economy, which aims to extract the most value out of resources and materials whilst in use, can act as a useful model for the resource sector: wherever one is placed along the supply chain from producer to consumer, we should all be supporting ways of producing resources cleanly and efficiently, with reduced, managed and – where possible – reused waste. And the management of mining waste has had increased profile in the past few years, with several tragic and preventable collapses of tailings dams which have had major societal and environmental consequences. Our role As reporters of the ReSToRE summer school, our role was to take note of the event and support the delivery of key outcomes. This meant that we were very busy capturing thoughts from participants, organisers, speakers and mentors through interviews, soaking in the atmosphere at the various social events and workshops, and carving out occasional moments to sit down by the lake at UCD and reflect on the week and how it was going. We relied on a trusted voice recorder and notebook, and quickly became acutely acquainted with the opening hours of cafés around campus. The participants’ WhatsApp group also proved incredibly useful for gaging how participants were feeling, as well as asking people to gather round for a photo, check a nationality or give advice on the best sights in Dublin, or pubs showing the Women’s World Cup. More importantly, the summer school provided opportunity to create a diverse, international network of like-minded individuals working in the interdisciplinary sphere, as well as enabling everyone involved, including participants, mentors, organisers and ourselves to learn, reflect, and to create potential new avenues for research and collaboration. One of the highlights has to be the mix of nationalities and cultures represented, as well as a general spirit of openness to new ideas and perspectives. Although the week was intense and the workshop participants were tasked with preparing presentations of their findings for the final day, the support and lack of competition amongst participants was palpable, and paved the way for creativity to emerge. Together, they created a safe space in which to be open, reflective, responsive and curious, and to bravely tackle some very complex questions. We hope to continue these conversations at the interface of societal issues and geoscience at future conferences, such as the EGU General Assembly 2020. We hope you are inspired to join in. See you there! By Anthea Lacchia (Irish Centre for Research in Applied Geosciences at University College Dublin) and Jen Roberts (University of Strathclyde) Find out more A suite of summer school resources, including live-streamed videos of the presentations and discussions by experts in the field and blogs from the delegates, can be found on the ReSTORE webpage: https://www.icrag-centre.org/restore/ iCRAG, the International Union of Geological Sciences and Geological Survey Ireland were the organising sponsors of ReSToRE, which was run under the patronage of UNESCO. Sponsorship also came from BHP, Boliden, Rio Tinto, Teck, with additional support received from Irish Research Council and UCD College of Business. About the authors Anthea Lacchia Anthea grew up in northern Italy, in a town at the foot of the Alps. Having studied Classics in high school in Italy, she moved to Ireland and obtained a BA in Geology from Trinity College Dublin.  During her undergraduate studies, she developed a keen interest in thinking about the lives of ancient animals preserved in rocks – fossils – which led her to pursue a PhD in palaeontology, specifically looking at extinct relatives of squid and cuttlefish called ammonoids. She spent many seasons of fieldwork perusing the rocks of Co. Clare, in western Ireland. In parallel with her research, she gained experience both in science writing and newspaper editing. Following completion of her PhD, she spent a year working as a press officer for Springer Nature in London. She then returned to Ireland to start postdoctoral research in iCRAG, the Irish Centre for Research in Applied Geosciences, in University College Dublin, where she is studying public perception and understanding of geosciences, with a focus on the geology and communities of Co. Clare. Her postdoc allows her to combine her passion for geology with that for science communication and public engagement. Anthea also works as a freelance science writer. Anthea took part in the ReSToRE Summer School as a reporter. Jen Roberts Jen is a...

Science Foundation Ireland has announced the 2021 National Crystal Growing Competition for primary and post-primary school students.

iCRAG companions with US start-up the use of AI to seek out metals for EVs Tech News Page

The SFI research centre will analyse mineral samples for Bill Gates-backed KoBold Metals. The post iCRAG partners with US start-up using AI to find metals for EVs appeared first on Silicon Republic.