Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain.

Importance: Guidelines recommend deprescribing opioids in older adults due to risk of adverse effects, yet little is known about patient-clinician opioid deprescribing conversations.

Objective: To understand the experiences of older adults and primary care practitioners (PCPs) with using opioids for chronic pain and discussing opioid deprescribing.

Design, Setting, And Participants: This qualitative study conducted semistructured individual qualitative interviews with 18 PCPs and 29 adults 65 years or older prescribed opioids between September 15, 2022, and April 26, 2023, at a Boston-based academic medical center.

Polygenic early-onset colorectal cancer in pediatric patients.

Colorectal cancer in the pediatric population is a rare but transpirable phenomenon. The occurrence should prompt suspicion for underlying genetic mutations in the setting of a hereditary cancer predisposition syndrome. In this series, we outline three pediatric patients with colonic adenocarcinoma who were found to have one or more germline mutations.

PEEDS-RAPEL: A case conceptualization model for evaluating pediatric cases with acquired brain injury.

Background: The needs of a child with an acquired brain injury (ABI) are not a scaled down version of those required by an adult with a brain injury who has impairments that impact their cognitive and physical or functional abilities, capacity for work, and/or independence in performing activities of daily living.

Purpose: The purpose of this article is to provide a standardized methodology for analysis of pediatric ABI cases when evaluating vocational potential as part of the child's future rehabilitation or life care planning. PEEDS-RAPEL, a case conceptualization model for rehabilitation professionals, is defined in the context of a tool or methodology for the evaluation of pediatric clients with ABI.

Fine-scale spatial genetic dynamics over the life cycle of the tropical tree Prunus africana.

Studying fine-scale spatial genetic patterns across life stages is a powerful approach to identify ecological processes acting within tree populations. We investigated spatial genetic dynamics across five life stages in the insect-pollinated and vertebrate-dispersed tropical tree Prunus africana in Kakamega Forest, Kenya. Using six highly polymorphic microsatellite loci, we assessed genetic diversity and spatial genetic structure (SGS) from seed rain and seedlings, and different sapling stages to adult trees.

Correlated loss of ecosystem services in coupled mutualistic networks.

Networks of species interactions promote biodiversity and provide important ecosystem services. These networks have traditionally been studied in isolation, but species are commonly involved in multiple, diverse types of interaction. Therefore, whether different types of species interaction networks coupled through shared species show idiosyncratic or correlated responses to habitat degradation is unresolved.

Effects of local tree diversity on herbivore communities diminish with increasing forest fragmentation on the landscape scale.

Forest fragmentation and plant diversity have been shown to play a crucial role for herbivorous insects (herbivores, hereafter). In turn, herbivory-induced leaf area loss is known to have direct implications for plant growth and reproduction as well as long-term consequences for ecosystem functioning and forest regeneration. So far, previous studies determined diverging responses of herbivores to forest fragmentation and plant diversity.

Additive effects of exotic plant abundance and land-use intensity on plant-pollinator interactions.

The continuing spread of exotic plants and increasing human land-use are two major drivers of global change threatening ecosystems, species and their interactions. Separate effects of these two drivers on plant-pollinator interactions have been thoroughly studied, but we still lack an understanding of combined and potential interactive effects. In a subtropical South African landscape, we studied 17 plant-pollinator networks along two gradients of relative abundance of exotics and land-use intensity.

Habitat characteristics of forest fragments determine specialisation of plant-frugivore networks in a mosaic forest landscape.

Plant-frugivore networks play a key role in the regeneration of sub-tropical forest ecosystems. However, information about the impact of habitat characteristics on plant-frugivore networks in fragmented forests is scarce. We investigated the importance of fruit abundance, fruiting plant species richness and canopy cover within habitat fragments for the structure and robustness of plant-frugivore networks in a mosaic forest landscape of South Africa.

Basics of burn injury: implications for case management and life care planning.

Case managers and life care planners are often appropriate professionals to assist with the care of people who have experienced burns. With more than 1,000,000 people who are burned each year, including 15,000 children who are hospitalized, the numbers of patients are substantial. Recovery from burns can be an extremely lengthy, complicated, and painful event.

Desmoplakin and Plakoglobin--specific markers of lymphatic vessels in the skin?

Monoclonal antibodies against Desmoplakin and Plakoglobin were tested for their suitability as specific markers of lymphatic vessels. The tissue samples were taken from horse skin in an attempt to establish the horse as a model for human lymphatic diseases. To obtain a clear, positive identification of blood and lymphatic vessels, immunohistochemical staining with antibodies against vascular endothelial growth factor receptor 3 (VEGFR-3) and platelet endothelial adhesion molecule (PECAM-1, CD31), was compared with Desmoplakin and Plakoglobin.

Comparison of MRI and discography in the diagnosis of lumbar degenerative disc disease.

Recent reports have attempted to compare the relative value of discography and MRI in the evaluation of lumbar degenerative disc disease. None has compared the accuracy of the two techniques in regard to the detection of disc herniation specifically, and none has offered surgical correlation. In this prospective study, both techniques were used to evaluate 264 disc levels in 90 patients with incapacitating low back pain or radicular pain.

Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation.

The pedicles of lumbar vertebrae were measured both directly and radiographically to determine the differences between the sexes and the accuracy of radiographic measurement. The lumbar pedicles of cadavera of forty-nine patients--twenty-four men and twenty-five women--who died between the ages of sixty and ninety-eight years were measured directly and on radiographs. The pedicles of lumbar vertebrae from fifty-one patients--twenty-three men and twenty-eight women--between the ages of twenty and fifty years who had low-back problems were measured on radiographs and computerized tomographic scans.

An effective surrogate for impact studies.

Nineteen unembalmed (fresh) cadavers were used in 21 experiments to test restraint systems in automobile impact studies. Some were mounted in a rearward firing sled; others were placed in standard cars during collisions. Prior to and after testing, each cadaver was evaluated.

Experimental studies on osteoporosis.

Nutritional secondary hyperparathyroidism (NSH) defines a spontaneous and experimental disease in most domesticated and in some wild animals, caused by dietary calcium deficiency and/or phosphorus excess. Calcium deficiency results directly in hypocalcemia, and phosphorus excess induces hyperphosphatemia which causes hypocalcemia. Secondary hyperparathyroidism thus results and the plasma parameters return to normal and are maintained but only at the expense of progressive bone loss.