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BACKGROUND: Ease of access to opioids in the perioperative period is a risk factor for subsequent opioid misuse. The purpose of this study was to quantify a decrease in opioid consumption following implementation of a new analgesic protocol after total knee arthroplasty (TKA). METHODS: A retrospective cohort study was performed analyzing patients who underwent TKA at a US Department of Veterans Affairs medical center. Patients were divided into 2 groups by multimodal analgesic regimen: Analgesia with intraoperative general anesthesia, a patient-controlled analgesia pump, and oral opioids (control group) or analgesia with intraoperative spinal anesthesia, a multimodal medication regimen, and an adductor canal block (protocol group). RESULTS: A total of 533 TKAs were included. The mean (SD) IV morphine equivalent dose (MED) requirement was 178.2 (98.0) for the control and 12.0 (24.6) for the protocol group (P < .001). Total mean (SD) opioid MED requirement was 241.7 (120.1) for the control group and 74.8 (42.7) for the protocol group (P < .001). The protocol group required only 6.7% of the IV opioids and the control group 30.9%. No difference in oral opioid requirements was found (P = .85). The control group required more opioid refills at the first postoperative visit (P < .001). CONCLUSIONS: The described analgesic protocol resulted in significant decreases in IV and total opioid requirement, and lower rates of opioid prescriptions at the first postoperative visit. These findings demonstrate a decrease in opioid utilization with modern perioperative analgesia protocols and reinforce multiple recommendations to decrease opioid exposure and access.

A defining feature of Viennese ballroom minuets in the second half of the eighteenth century is the marked contrast between the first and second minuet (commonly called the trio). The type of contrast was standardised within a rather narrow and predictable range. Minuets were loud, employed the full orchestra and had walking bass lines in predominantly crotchet motion. Trios were soft, employed a reduced orchestra and used a slower harmonic rhythm. Focusing on Mozart's minuets written for the ballroom, an argument is advanced as to why such sharp contrast might have been desirable. Drawing on historical and analytical evidence, it is suggested that the music of the first minuet establishes the historical authority, political power and social status of the participants of the dance, while the trio is centred artistically on the grace and beauty displayed by the individual couple on the ballroom dance floor.

The purpose of this study was to determine the cardiovascular health needs of university students living in residence. A survey was administered to students living in residences at a university in Nova Scotia, Canada to identify eating patterns, physical activity, smoking behaviours and perceived stress. Data were analyzed using descriptive statistics and chi-square tests of association. Qualitative data were collected using focus group interviews. Results showed that fewer than half of the students participated in exercise three or more times per week, and 82% ate less than the recommended amount of fruits and vegetables. As perceived knowledge of CVD increased so did level of physical activity and consumption of fruits and vegetables. Fifty-six percent of students rated their stress as high or very high; exams and course assignments are a major cause of this stress. Fifteen percent of the university students surveyed were daily smokers. Barriers to a healthy lifestyle include time constraints and limited food choices in the residence cafeteria.

In approaching tonal form from a Schenkerian perspective, three aspects of the music need to be considered: the articulations of harmonic/voice-leading levels from the background to the foreground, the articulations of the musical surface, and the nature and function of the interaction between the underlying levels of harmony and voice leading and the musical surface. The second and third aspects are what