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Background Acute calculous cholecystitis (ACC) is the most common complication of cholelithiasis. Laparoscopic cholecystectomy (LC) is the gold standard treatment in mild and moderate forms. Currently there is consensus for the use of antibiotics in the preoperative phase of ACC. However, the need for antibiotic therapy after surgery remains undefined with a low level of scientific evidence. Methods The CHART (Cholecystectomy Antibiotic Randomised Trial) study is a single-center, prospective, double blind, and randomized trial. Patients with mild to moderate ACC operated by LC were randomly assigned to receive antibiotic (amoxicillin/clavulanic acid) or placebo treatment for 5 consecutive days. The primary endpoint was postoperative infectious complications. Secondary endpoints were as follows: (1) duration of hospital stay, (2) readmissions, (3) reintervention, and (4) overall mortality. Results In the per-protocol analysis, 6 of 104 patients (5.8%) in the placebo arm and 6 of 91 patients (6.6%) in the antibiotic arm developed postoperative infectious complications (absolute difference 0.82 (95% confidence interval, −5.96 to 7.61, P = .81). The median hospital stay was 3 days. There was no mortality. There were no differences regarding readmissions and reoperations between the 2 groups. Conclusion Although this trial failed to show noninferiority of postoperative placebo compared to antibiotic treatment after LC for mild and moderate ACC within a noninferiority margin of 5%, the use of antibiotics in the postoperative period does not seem justified, because it was not associated with a decrease in the incidence of infectious and other types of morbidity in the present study. [ABSTRACT FROM AUTHOR]

It was shown that estimation of fatigue lives of welded joints can be successfully carried out by considering the fatigue process as a fatigue crack growth from the initial intrinsic crack size of a 0 =ρ* until the final crack a f . Such an approach avoids a somewhat arbitrary division of the fatigue process into the crack initiation and propagation and concentrates on using only one methodology - the fracture mechanics theory. The stress intensity factors can be determined in such cases by the weight function method. The proposed methodology allows estimation of the fatigue life under both constant and variable amplitude loading. [ABSTRACT FROM AUTHOR]

Mortality associated with opioids continues to rise. According to the CDC's latest reports, in 2017 there were a total of 47,600 opioid-related overdose deaths, compared with 42,250 from 2016 resulting in increases in mortality across all ages, racial, ethnic groups and geographic regions. [1] The research literature and news media have described the role of different aspects of the medical community in this crisis. [2,3] Medical specialties have evaluated prescribing patterns for different physician specialities, demonstrating that PM&R physicians prescribe opioids at one of the highest rates. [4] The purpose of this study is to describe the opioid prescribing patterns of physical medicine and rehabilitation physicians in acute inpatient rehabilitation (AIR). Using a retrospective, cross-sectional study design, opioid prescription orders placed between July 1st 2017 and July 1st 2018 were reviewed at a single free-standing acute inpatient rehabilitation hospital in Chicago, IL. Descriptive data was analyzed using R statistical software (version R-3.5.2). There were a total of 1,266 inpatient opioid medication orders written (out of a total of 28,301 medication orders for all drugs). There were 480 patients who received these prescriptions. Seven different types of opioid pain medications were prescribed: hydrocodone-acetaminophen (APAP), oxycodone, methadone, morphine, hydromorphone, fentanyl, and tramadol which were prescribed in 24 different dosing formulations (i.e. Norco 5 mg vs. 10 mg or liquid vs. tab). There were 692 (54.7%) hydrocodone-APAP prescriptions, 395 (31.2%) tramadol, 80 (6.3%) oxycodone, 33 (2.6%) methadone, 27 (2.1%) morphine, 23 (1.8%) hydromorphone, and 16 (1.3%) fentanyl. The composite opioid prescribing rate for 2017-2018 in AIR is 4.5%. This project is the first step in a larger quality improvement project evaluating analgesic prescribing in AIR among physical medicine and rehabilitation physicians. References [1] Scholl L. Drug and Opioid-Involved Overdose Deaths – United States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427. [Accessed 1/13/2019] [2] Quinones, S. Dreamland: the True Tale of America's Opiate Epidemic. Bloomsbury YA, 2015. [3] Bohnert ASB. Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths. JAMA. 2011;305(13):1315–1321. doi:10.1001/jama.2011.370 [4] Levy B. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012. Am J Prev Med. 2015;49(3):409–41 [ABSTRACT FROM AUTHOR]

We enrolled 345 fourth-grade students in a classroom-randomized, controlled trial to evaluate a school-based West Nile virus health education program''s impact on knowledge, attitudes, and personal protective behavior use. Immediate and sustained improvements in West Nile virus knowledge and greater frequencies of reported personal protective behaviors resulted from the educational intervention. [Copyright &y& Elsevier]