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Prescription opioids were identified as being responsible for 14,000 deaths in 2019, with 9.3 million people admitting to misuse in 2020. This quality improvement project implemented the Institute for Clinical Systems Improvement (ICSI) guideline on pain management in acute care to decrease opioid prescriptions >90 morphine milliequivalents for acute-on-chronic pain. The change to current practice included completion of comprehensive functional assessments and opioid risk screening tools to guide a goal-directed shared decision-making discussion with patients. There was a statistically significant decrease in morphine milliequivalents per prescription (t43 = 2.579, P = .013).

BackgroundAlthough several cross-sectional studies have shown that aircraft noise exposure was associated with an increased risk of hypertension, a limited number of longitudinal studies have addressed this issue. This study is part of the DEBATS (Discussion on the health effect of aircraft noise) research programme and aimed to investigate the association between aircraft noise exposure and the incidence of hypertension.MethodsIn 2013, 1244 adults living near three major French airports were included in this longitudinal study. Systolic and diastolic blood pressure, as well as demographic and lifestyle factors, were collected at baseline and after 2 and 4 years of follow-up during face-to-face interviews. Exposure to aircraft noise was estimated for each participant’s home address using noise maps. Statistical analyses were performed using mixed Poisson and linear regression models adjusted for potential confounding factors.ResultsA 10 dB(A) increase in aircraft noise levels in terms of Ldenwas associated with a higher incidence of hypertension (incidence rate ratio (IRR)=1.36, 95% CI 1.02 to 1.82). The association was also significant for Lday(IRR 1.41, 95% CI 1.07; to 1.85) and Lnight(IRR 1.31, 95% CI 1.01 to 1.71). Systolic and diastolic blood pressure increased with all noise indicators.ConclusionThese results strengthen those obtained from the cross-sectional analysis of the data collected at the time of inclusion in DEBATS, as well as those from previous studies conducted in other countries. Hence, they support the hypothesis that aircraft noise exposure may be considered as a risk factor for hypertension.

Proline is found in a cis conformation in proteins more often than other proteinogenic amino acids, where it influences structure and modulates function, being the focus of several high-resolution structural studies. However, until now, technical and methodological limitations have hampered the site-specific investigation of the conformational preferences of prolines present in poly proline (poly-P) homorepeats in their protein context. Here, we apply site-specific isotopic labeling to obtain high-resolution NMR data on the cis/trans equilibrium of prolines within the poly-P repeats of huntingtin exon 1, the causative agent of Huntington’s disease. Screening prolines in different positions in long (poly-P11) and short (poly-P3) poly-P tracts, we found that, while the first proline of poly-P tracts adopts similar levels of cis conformation as isolated prolines, a length-dependent reduced abundance of cis conformers is observed for terminal prolines. Interestingly, the cis isomer could not be detected in inner prolines, in line with percentages derived from a large database of proline-centered tripeptides extracted from crystallographic structures. These results suggest a strong cooperative effect within poly-Ps that enhances their stiffness by diminishing the stability of the cis conformation. This rigidity is key to rationalizing the protection toward aggregation that the poly-P tract confers to huntingtin. Furthermore, the study provides new avenues to probe the structural properties of poly-P tracts in protein design as scaffolds or nanoscale rulers.

Le parcours éducatif de santé pour tous les élèves, dont le principe est posé par la loi, prend consistance au fil du temps. Les analyses des besoins, assises sur l’expérience, ont permis la mise en place d’un plan ambitieux qui fait de parcours éducatif de santé un droit opposable. L’ensemble est structuré par les textes, dont un important arrêté du 3 novembre 2015, qui définit la complémentarité de l’action des médecins et des infirmier(e)s.

Background: Over the last decade, several coral genomes have been sequenced allowing a better understanding of these symbiotic organisms threatened by climate change. Scleractinian corals are reef builders and are central to coral reef ecosystems, providing habitat to a great diversity of species. Results: In the frame of the Tara Pacific expedition, we assemble two coral genomes, Porites lobataand Pocilloporacf. effusa,with vastly improved contiguity that allows us to study the functional organization of these genomes. We annotate their gene catalog and report a relatively higher gene number than that found in other public coral genome sequences, 43,000 and 32,000 genes, respectively. This finding is explained by a high number of tandemly duplicated genes, accounting for almost a third of the predicted genes. We show that these duplicated genes originate from multiple and distinct duplication events throughout the coral lineage. They contribute to the amplification of gene families, mostly related to the immune system and disease resistance, which we suggest to be functionally linked to coral host resilience. Conclusions: At large, we show the importance of duplicated genes to inform the biology of reef-building corals and provide novel avenues to understand and screen for differences in stress resilience.

Catchments respond to rainfall by storing and releasing water according to their internal dynamics. Groundwater had long been treated as the slow reservoir in this process, but isotopic measurements showed how responsive it can be. Here, we investigate the mechanics of groundwater's contribution to floods. To do so, we monitored over 3 years the shape of the water table in, and the runoff out of, a small tropical catchment. We find that groundwater and runoff respond within minutes of a rainfall event. Using an asymptotic theory inspired by recent laboratory experiments, we suggest that the peak water discharge at the catchment's outlet increases like the rainfall rate to the power of 3/2. This formula consistently predicts the stream's response to the 137 isolated rainfall events recorded during our field survey. In addition, its prefactor yields an estimate of the average groundwater storage. Rainwater infiltrates into the ground, accumulates in porous rocks, and eventually flows toward a neighboring stream. Although this underground travel often takes millennia, groundwater can contribute quickly to floods. To understand how an underground flow can be so responsive, we have recorded the motion of the groundwater surface in a small tropical catchment during 3 years. We find that groundwater swells within minutes of a rain event and that this deformation directly pushes more water into the stream. The resulting stream‐discharge peak strengthens faster than the rainfall intensity: A threefold increase of the latter causes a fivefold increase of the stream discharge. Including this mechanism into flood‐forecasting models should allow us to better predict the impact of extreme precipitations. Finally, we introduce a method to measure how much water an aquifer stores during a rainfall event, before releasing it—a central parameter for the management of water resources. High‐frequency measurements show that groundwater nonlinearly amplifies the response of a catchment to rainfall eventsThe stormflow regime of the underground flow consistently predicts the peak runoffWe propose a method to measure the volume of water available in a shallow aquifer based on the hydrograph of the corresponding catchment