OBJECTIVE: Post-operative patients are at increased risk of becoming chronic users of opioids, and overprescribing can lead to abuse and diversion. Though data have shown a decrease in opioid prescriptions nationally, limited studies have specifically evaluated the influence of state legislation on this trend. This study aimed to assess the impact of legislation in the state of Tennessee on opioid prescribing amongst orthopedic surgeons. DESIGN: This retrospective cohort analysis evaluated patients who received opioids post-orthopedic surgery before and after the state legislation was passed. SETTING: A community teaching hospital. PATIENTS AND PARTICIPANTS: Two hundred and three post-orthopedic surgery patients were included, with 101 in the preleg-islation and 102 in the post-legislation groups. INTERVENTIONS: State legislation in Tennessee limiting amounts of prescribed opioids went into effect in July 2018. MAIN OUTCOME MEASURE(S): The primary outcome was total morphine milligram equivalents (MMEs) prescribed, with secondary outcomes of days' supply, dosage units, and MME per day. RESULTS: Orthopedic surgery patients in the post-legislation arm were prescribed significantly fewer MME than those in the prelegislation arm (median MME 375 vs. 562.5; p < 0.001). Prescription days' supply, number of dosage units, and MME per day were also significant lower in the post-legislation group. CONCLUSIONS: After orthopedic surgery, patients in the post-legislation arm were prescribed a median 187.5 MME less than those in the prelegislation arm. Our findings suggest that state opioid legislation is associated with a reduction in the amount of opioids prescribed in certain orthopedic surgery patients, though further studies evaluating adequacy of pain control are warranted.

No description available.

No description available.

Background: Neuropilin (NRP) is a transmembrane protein, which has been shown to be a pro-angiogenic mediator and implicated as a potential driver of cancer progression. NRP-1 up-regulation in ovarian cancer tissue predicts poor prognosis. However, the clinical relevance of the soluble form of NRP-1 (sNRP-1) as a circulating biomarker in ovarian cancer patients is unknown. - Methods/patients cohort: sNRP-1 levels were quantified in a cohort of 88 clinically documented ovarian cancer patients by a commercially available sNRP-1 enzyme-linked immunosorbent assay (ELISA) kit (Biomedica, Vienna, Austria). Patients (81.8% with FIGOIII/IV) received primary cytoreductive surgery with the aim of macroscopic complete resection (achieved in 55.7% of patients) and the recommendation of adjuvant chemotherapy in line with national guidelines. - Results: Higher levels of sNRP-1 reflected more advanced disease (FIGO III/IV) and indicated a trend towards suboptimal surgical outcome, i.e. any residual tumor. sNRP-1 was neither related to the patients’ age nor the BRCA1/2 mutational status. Patients with higher sNRP-1 levels at primary diagnosis had a significantly reduced progression-free survival (PFS) (HR = 0.541, 95%CI: 0.304 - 0.963; p = 0.037) and overall survival (OS) (HR = 0.459, 95%CI: 0.225 - 0.936; p = 0.032). Principal component analysis showed that sNRP-1 levels were unrelated to the circulating hepatocyte growth factor (HGF) and the soluble ectodomain of its receptor the tyrosine kinase mesenchymal–epithelial transition (c-MET), suggesting that there is no proportional serological concentration gradient of soluble components of the NRP-1/HGF/c-MET signaling axis. - Conclusions: In line with the previously shown tissue-based prognostic role, we demonstrated for the first time that sNRP-1 can also act as a readily accessible, prognostic biomarker in the circulation of patients with ovarian cancer at primary diagnosis. Given its known role in angiogenesis and conferring resistance to the poly ADP-ribose polymerase (PARP) inhibitor olaparib in vitro, our results encourage more detailed investigation into sNRP-1 as a potential predictive biomarker for bevacizumab and/or PARP-inhibitor treatment.

Arts and Humanities Research Council, through a Collaborative Doctoral Partnership studentship / The full text will be available at the end of the embargo period

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25159号 / 医博第5045号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 森田 智視, 教授 永井 洋士 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Minne, stress och sömn är tre faktorer som påverkar en individs välbefinnande, hälsa och prestation. Sömn- och stressproblematik har under de senaste åren ökat såväl hos vuxna som hos universitetsstudenter. Sömnbesvär och stress är en negativ bidragande faktor till studenters studieresultat. Retrospektiva minnen (RM) är en typ av bakåtriktade minnen medan prospektiva minnen (PM) är en typ av framåtriktade minnen. Det finns tidigare forskning som visar att vuxna tenderar att ha större minnesproblem kopplat till PM än till RM. En anledning till detta kan vara att de använder sig av olika perceptuella och kognitiva processer. Samtidigt finns det forskning som visar att stress påverkar både RM och PM negativt. Studier har visat att sömnproblem har ökat hos studenter under de senaste åren. Studenter utsätts för höga krav i form av föreläsningar, lektioner och examinationer under deras studietid som i sin tur kan leda till ökad stress. Ökad stress kan därmed leda till ökade sömnsvårigheter och försämrade resultat vid minnestester. Föreliggande studie hade som syfte att undersöka sambandet mellan prospektivt minne, retrospektivt minne, stress och sömn hos 90  universitetsstudenter. Den ämnade också undersöka om det fanns några skillnader mellan RM och PM och om dessa skillnader kunde bero på stress och sömn. Samtliga faktorer i studien var baserade på självskattade enkätsvar. Det fanns ett medelstark samband mellan stress och minnessvårigheter samt mellan sömnbesvär och stress. Studenterna upplevde sig ha något sämre PM än RM. Stress och sömn låg inte bakom skillnaden mellan PM och RM. / Memory, stress, and mind are three factors affecting an individual's well-being, health, and performance. In recent years, problems related to sleep and stress have increased both for adults and for university students. Problems related to sleep and stress are a negative contributing factor to a students' study results. Retrospective memories (RM) are a type of backward memories while prospective memories (PM) are a type of forward memories. There is previous research showing that adults tend to have greater memory problems linked to PM rather than to RM. One reason for this may be that they use different perceptual and cognitive processes. On the other hand, there is research showing that stress affects both RM and PM negatively. There are studies showing increased sleeping problems for students in recent years. Students are exposed to high demands because of lectures, lessons, and examinations during their studies, which in turn can lead to increased stress. Increased stress can thus lead to increased sleep difficulties and impaired results in memory tests. The aim of this study was to investigate the relationship between prospective memory, retrospective memory, stress, and sleep in 90 university students. It also aimed to investigate whether there were any differences between RM and PM and whether these differences could be due to stress and sleep. All factors in the study were based on self-reported questionnaire responses. There was a medium-strong relationship between stress and memory difficulties and between sleep problems and stress. The students felt that they had slightly worse PM than RM. Stress and sleep were not a reason behind the difference between PM and RM.

Yes / The frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%-2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% -1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR) = 2.19, (1.90-2.54, p<0.001)) and adults (IRR 2.26, (2.01-2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation.

Das Feld der diskursiven und auch normativen Bestimmungen des Archivbegriffes ist in den letzten Jahren in Bewegung geraten. Das betrifft auch Fragen nach dem Zugang zu Geschichten der Aufführungskünste und die Praxis von Archivprozessen und Sammeltätigkeiten in künstlerischen und kuratorischen Kontexten. Dieses Arbeitsbuch fasst Ergebnisse des Forschungsprojekts „Verzeichnungen. Medien und konstitutive Ordnungen von Archivprozessen der Aufführungskünste“ zusammen. Es wurde zwischen 2012 und 2017, gefördert von der DFG, in Leipzig und Berlin durchgeführt. Enthält: Performance im Museum als Historisierung; Performance der Institution Museum; Performancekunst an der Schnittstelle von visueller und darstellender Kunst; Sammeln und Archivieren als Themen der Kunst; US-amerikanische Performancekunst; Performa New York; Rituals of Rented Island New York; Radical Presence/ Black Performance; Karneval und Performance; Performancekunst in/aus Osteuropa; Reenactment und Re-Staging; MUMOK Factory und Tanzquartier Wien; dispositive Konstellationen Museum und Theater / The discursive and normative field of archivalities has considerably shifted in recent years. This shift also concerns questions of access to histories of performance-based arts as well as archival practices both in artistic and curatorial contexts. This workbook presents results of the research project “Records and Representations. Media and constitutive systems of archiving performance-based arts” conducted between 2012 and 2017 in Leipzig and Berlin with funding by DFG (German Research Foundation).

The issue of the vertical /or horizontal operation of the Bill of Rights (chapter 3) is a controversial one. The interim constitution deals with this controversy in a subtle way by avoiding direct horizontal operation of Chapter 3. Instead, it provides for the so-called 'seepage to horizontal relationships' in terms of section35{3). This apparently was a political compromise between the pro-vertical only and the pro-horizontal groups. The human rights history of this country justifies a Bill of Rights that would have both vertical and horizontal operation. However, in section 35 (3) there is potential for the values enshrined in the constitution and Chapter 3, and the spirit hereof, to permeate and filter through the entire legal system in all it's applications. It would seem, however, as demonstrated by the decision in De Klerk v Du Plessis, that the extent to which this filtering process will benefit individuals in their private relations, will depend on the interpretation given to section 35 (3) by the courts. If courts, as it happend in De Klerk's case fail to realise the full import of section 35 ( 3) aspects of the existing law which are unjust could remain and the process of creating a just, open and democratic society will be hampered. / Constitutional, International & Indigenous Law / LL.M.