Opioid stewardship has been widely used to promote rational use, monitoring and discontinuation of opioid therapy; however, its definition and scope of practice remain unclear.
To synthesize ...definitions of opioid stewardship proposed by clinical practice guidelines and professional societies, and to offer a proposal for a universally acceptable definition.
Systematic literature searches were performed (earliest records to May 2022) in six databases (MEDLINE, EMBASE, APA PsycINFO, Scopus, and CENTRAL) and grey sources guidelines development bodies and professional societies through Google. The conventional but widely applied content analysis and word frequencies were used to analyze the definitions and scope of practice.
After removing duplicates, 449 articles were retrieved (439 databases and registers and 11 from other sources), 19 of which included a definition of "opioids stewardship". A total of 12 themes was identified in the definitions, including 1) improvement or appropriateness of prescribing opioids use, 2) mitigation of risk from opioids, 3) monitoring opioid use, 4) evaluation of opioid use, 5) judicious opioid use, 6) appropriateness of opioid disposal, 7) identification and treatment of opioid use disorder, 8) reduction in mortality associated with opioid overdoses, 9) appropriate procurement practices, 10) appropriate storage, 11) promoting better communications between patients and prescribers including education provision and 12) patient-centered decision-making.
Opioid stewardship is inconsistently defined across professional and research literature. While there is a greater focus on appropriateness and need for improvement of prescribing and monitoring of opioid use, the importance of communications between patients and prescribers, and patient involvement in both prescribing and deprescribing decision-making remains sparse. A comprehensive definition has been proposed as part of the work. There is a need to develop and validate the proposed definition and scope of practice to promote rationale for opioid prescribing, use and attainment of favourable outcomes through international consensus involving practitioners, researchers, and patients.
N-methyl-d-aspartate (NMDA) receptor (NMDAR) hypofunction plays a key role in pathophysiology of schizophrenia. Since NMDAR hypofunction has also been reported in autism, Alzheimer’s disease and ...cognitive dementia, it is crucial to identify the location, timing, and mechanism of NMDAR hypofunction for schizophrenia for better understanding of disease etiology and for novel therapeutic intervention. In this review, we first discuss the shared underlying mechanisms of NMDAR hypofunction in NMDAR antagonist models and the anti-NMDAR autoantibody model of schizophrenia and suggest that NMDAR hypofunction could occur in GABAergic neurons in both models. Preclinical models using transgenic mice have shown that NMDAR hypofunction in cortical GABAergic neurons, in particular parvalbumin-positive fast-spiking interneurons, in the early postnatal period confers schizophrenia-related phenotypes. Recent studies suggest that NMDAR hypofunction can also occur in PV-positive GABAergic neurons with alterations of NMDAR–associated proteins, such as neuregulin/ErbB4, α7nAChR, and serine racemase. Furthermore, several environmental factors, such as oxidative stress, kynurenic acid and hypoxia, may also potentially elicit NMDAR hypofunction in GABAergic neurons in early postnatal period. Altogether, the studies discussed here support a central role for GABAergic abnormalities in the context of NMDAR hypofunction. We conclude by suggesting potential therapeutic strategies to improve the function of fast-spiking neurons.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Retrieving a set of 143 cryptocurrencies for a sample spanning 2014–2018, we investigate the popular momentum strategy implemented in the cryptocurrency market. Contrary to earlier studies our ...findings do not indicate any evidence of significant momentum payoffs, supporting the view that the cryptocurrency market is far more efficient than suggested in earlier studies.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Coastal wetland loss through marsh edge erosion is a serious problem in Louisiana. The majority of studies on coastal land loss use aerial and satellite photographic analysis while field and ...site-specific measurements are limited. The aim of this study was to spatially and temporally measure coastal marsh edge erosion and investigate factors responsible for differences in erosion including shoreline orientation, soil physio-chemical properties, and wind speed and duration. A total of 33 transects across six island sites in northern Barataria Basin, Louisiana were established. Transects on shorelines facing different compass directions were measured for erosion for up to 2 years. Soils were analyzed for physiochemical properties including bulk density, organic matter, total carbon, nitrogen, and phosphorus. Bathymetric surveys were conducted to determine the extent of the erosive bay bottom profile. In addition, 14C dating of the basal organic matter (1.5–1.6 m) was conducted. Erosion rates ranged from 49.27 to 324.85 cm y-1 with a mean value of 141.69 ± 22.45 cm y−1. As expected, erosion rates were significantly different (p < 0.001) between protected and unprotected sites. The erosion rate was not correlated with wind speed (r = -0.07), weakly correlated with compass direction of shoreline (r = 0.25) and water level (r = 0.25) but strongly correlated with duration of wind (r = 0.60). Erosion rate was negatively correlated (r = -0.45) with bulk density and positively correlated with organic matter content (r = 0.42) of the top 40 cm of the soil. Over time, the marsh is eroded down to a depth of 1.5 m, which correlates to annual loss of 1.82 ± 0.29 m3 volume of marsh per meter shoreline length including a loss of organic matter (141.5 ± 22.55 kg m−1) and carbon (63.32 ± 10.09 kg m−1) previously preserved for up to 850 years. As a consequence, annual CO2 emissions for Barataria Basin were estimated to be 1.56 ± 0.26 million tCO2e y−1. Results can inform coastal managers as to the most vulnerable marshes to target restoration efforts. Due to high relative sea level rise in coastal Louisiana, these results can also be used to inform the world's stable coastlines on the relative vulnerability of their coastal marshes in the near future, due to projected eustatic sea level. Consequently, the eroding coastlines across the globe may be a significant source of CO2 emissions in near future, as millennial age stored soil carbon is released in a relatively short time, potentially overwhelming human efforts to slow rising atmospheric CO2 levels.
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•The marshes in coastal Louisiana are eroding at rates ranging from 49.27 to 324.85 cm y−1.•The marsh edge erosion rate is primarily influenced by the duration of the wind not the velocity.•Marshes with higher bulk density erode more slowly.•Globally, coastal marshes may be a significant source of CO2 emissions in near future as sea level rise increases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Vibrio vulnificus and V. parahaemolyticus in the estuarine-marine environment are of human health significance and may be increasing in pathogenicity and abundance. Vibrio illness originating from ...dermal contact with Vibrio laden waters or through ingestion of seafood originating from such waters can cause deleterious health effects, particularly if the strains involved are resistant to clinically important antibiotics. The purpose of this study was to evaluate antimicrobial susceptibility among these pathogens. Surface-water samples were collected from three sites of recreational and commercial importance from July to September 2009. Samples were plated onto species-specific media and resulting V. vulnificus and V. parahaemolyticus strains were confirmed using polymerase chain reaction assays and tested for antimicrobial susceptibility using the Sensititre® microbroth dilution system. Descriptive statistics, Friedman two-way Analysis of Variance (ANOVA) and Kruskal-Wallis one-way ANOVA were used to analyze the data. Vibrio vulnificus (n = 120) and V. parahaemolyticus (n = 77) were isolated from all sampling sites. Most isolates were susceptible to antibiotics recommended for treating Vibrio infections, although the majority of isolates expressed intermediate resistance to chloramphenicol (78% of V. vulnificus, 96% of V. parahaemolyticus). Vibrio parahaemolyticus also demonstrated resistance to penicillin (68%). Sampling location or month did not significantly impact V. parahaemolyticus resistance patterns, but V. vulnificus isolates from St. Martin's River had lower overall intermediate resistance than that of the other two sampling sites during the month of July (p = 0.0166). Antibiotics recommended to treat adult Vibrio infections were effective in suppressing bacterial growth, while some antibiotics recommended for pediatric treatment were not effective against some of the recovered isolates. To our knowledge, these are the first antimicrobial susceptibility data of V. vulnificus and V. parahaemolyticus recovered from the Chesapeake Bay. These data can serve as a baseline against which future studies can be compared to evaluate whether susceptibilities change over time.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Reduction of the under-5 mortality rate is a target of the Sustainable Development Goals. Therefore, this study aimed to estimate under-5 child mortality rates in 52 low-migration countries using ...population data. The study utilized population data from the US Census Bureau from 1990 to 2015. The method involved first estimating mortality rates for countries with negligible net migration and then applying these rates to countries with matching mortality profiles, where it is reasonable to assume that migration is negligible for children under the age of 5 years. The highest child mortality was concentrated in the African region, followed by Asia and the Western region. However, steady progress in child mortality trends was concentrated in low-income countries. This simple method demonstrated that child mortality has significantly improved in high-income countries, followed by middle- and low-income countries. To reduce the under-5 mortality rates even further in these 52 countries, there is a need to accelerate equitable plans and policies related to child health to promote children's longevity and survival.
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NUK, OILJ, UL, UM, UPUK, VSZLJ
Abstract
Two-dimensional membranes have gained enormous interest due to their potential to deliver precision filtration of species with performance that can challenge current desalination membrane ...platforms. Molybdenum disulfide (MoS
2
) laminar membranes have recently demonstrated superior stability in aqueous environment to their extensively-studied analogs graphene-based membranes; however, challenges such as low ion rejection for high salinity water, low water flux, and low stability over time delay their potential adoption as a viable technology. Here, we report composite laminate multilayer MoS
2
membranes with stacked heterodimensional one- to two-layer-thick porous nanosheets and nanodisks. These membranes have a multimodal porous network structure with tunable surface charge, pore size, and interlayer spacing. In forward osmosis, our membranes reject more than 99% of salts at high salinities and, in reverse osmosis, small-molecule organic dyes and salts are efficiently filtered. Finally, our membranes stably operate for over a month, implying their potential for use in commercial water purification applications.
Climate change and population growth are contributing to a growing global freshwater crisis that is exacerbating agricultural water scarcity and compromising food security and public health. In light ...of these challenges, the increased reliance on nontraditional irrigation water sources, such as reclaimed or recycled water, is emerging as a potentially viable strategy to address water and food insecurity worldwide. This editorial provides an overview of the global need for agricultural water reuse and outlines the environmental and public health impacts associated with this practice. Policy implications, including an emphasis on “One Water” approaches, are discussed. Finally, the editorial leads off a Special Issue that includes a collection of articles reporting on the initial research and extension/outreach findings of CONSERVE: A Center of Excellence at the Nexus of Sustainable Water Reuse, Food and Health, funded by the U.S. Department of Agriculture, National Institute of Food and Agriculture. Taken together, this compilation of articles addresses the overarching theme that transdisciplinary teams are key with regard to moving the science of agricultural water reuse forward to achieve water and food security and advance public health in a changing climate.
•The planet is in the midst of a growing freshwater crisis.•Agricultural water reuse is increasing globally to offset water scarcity.•Agricultural water reuse can result in environmental and public health impacts.•Israel’s experience, along with One Water approaches, can inform water reuse policy.•Transdisciplinary teams can move the science of agricultural water reuse forward.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Migration of metals along a carbon chain is triggered by two of the most common organometallic elementary steps - β-hydride (β-H) elimination and alkene hydrometallation. This process heralds a new ...future for creating bonds at carbon sites that fall outside the tenets of the conventional wisdom for reactivity and bond formation, and provides an opportunity to leverage β-H elimination to advance the very reaction of alkene difunctionalization it is intrinsically predestined to disrupt. Almost four decades since its genesis, the early adventure for alkene difunctionalization by metal migration was sporadic, and its later development went on a hiatus primarily due to original impetus on arresting β-H elimination for vicinal alkene difunctionalization. With the recent surge on alkene difunctionalization, efforts have been gradually shifting to harnessing the process of β-H elimination to difunctionalize alkenes at sites other than the classical vicinal carbons, termed henceforth nonclassical reaction sites for pedagogical simplicity. In this review article, we extricate and examine the origin and the development of such reactions over the years. This review covers a wide range of reactions for the difunctionalization of alkenes at geminal (1,1), allylic (1,3) and remote (1,
n
) carbon sites with a variety of coupling partners. These reactions have enabled engineering of complex molecular frameworks with the generation of new carbon-carbon (C-C)/C-C, C-C/C-heteroatom (halogens, O, N, B) and C-B/C-B bonds. The development of these unique transformations is also presented with mechanistic hypotheses and experimental evidences put forward by researchers. Judged by the number of reports emerging recently, it is now strikingly evident that the field of alkene difunctionalization by metal migration has begun to gain momentum, which holds a great future prospect to develop into a synthetic method of enormous potential.
Alkenes can be difunctionalized at unconventional carbon sites by the migration of transition metals through β-hydride elimination and hydrometallation steps.
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IJS, KILJ, NUK, UL, UM, UPUK
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