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Select Drug Category Opiates/Opioids Topic Tolerance/Dependence Abstract Detail Clinical - Epidemiology Abstract Category Original Research Characterize the relationship between intraoperative opioid administration and postoperative pain and opioid requirements. We conducted a retrospective cohort study of 61,250 adult patients who received non-cardiac surgery under general anesthesia at a quaternary care center between 2016 and 2020. The exposure variable was intraoperative fentanyl and intraoperative hydromorphone average effect site concentration. The primary study outcomes were maximal pain score during post-anesthesia care unit (PACU) stay and cumulative opioids administered in the PACU in morphine milligram equivalents (MME). Secondary outcomes included frequency of uncontrolled pain at 24 hours, new instances of chronic pain diagnosis, total opioid use at 24 hours and in-hospital, opioid prescriptions at 30, 90, and 180 postoperative days, frequency of new persistent opioid use, maximal pain score in the first 24 hours and in-hospital, and incidence of opioid related complications in PACU. We used multivariate propensity weighting to control for confounding and estimated the counterfactual difference in outcomes after administration of an additional 100 mcg fentanyl or 500 mcg hydromorphone intraoperatively. Increased intraoperative fentanyl and intraoperative hydromorphone were both associated with reduced maximum pain scores in the PACU. Both exposures were also associated with a reduced probability and reduced total dosage of opioid administration in the PACU. We found that increased fentanyl administration in particular was associated with lower frequency of uncontrolled pain, decreased chronic pain at 3-months, fewer opioid prescriptions at 30-, 90-, and 180-days, and decreased persistent opioid use, without significant increases in side effects. Our results show that intraoperative opioid administration is significantly associated with short- and long-term effects on post-operative pain and opioid outcomes. Contrary to prevailing trends, reduced opioid administration during surgery may have the unintended consequence of increasing postoperative pain and opioid consumption. Our analysis suggests that significant improvements in long-term outcomes might be achieved by optimizing opioid administration during surgery. [ABSTRACT FROM AUTHOR]

Background: Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day units; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods: We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results: We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions: The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established. [ABSTRACT FROM AUTHOR]

The current study investigated how engagement in cultural activities impacted transracial adoptive parent satisfaction with adoption, closeness with child, and child academic outcomes. Data from the National Survey of Adoptive Parents were analyzed to expand upon previous studies. Confirmatory factor analyses were used to determine a "cultural activities" variable that consisted of five items. Results of regression analyses demonstrated significant associations between cultural activities and parent satisfaction with adoption, cultural activities and closeness with child, and cultural activities and child academic performance. A cultural receptivity process model informs the advocacy of cultural activity engagement in transracially adoptive families. [ABSTRACT FROM AUTHOR]

This study examines differentiated government control over foundations in China. The distinct patterns of "Harmonious Society" and "obeying the law" in foundation mission statements indicate a two-dimensional control mechanism in which the government intends to seek functional conformity and behavioral conformity from foundations. Using the multinomial logistic regression method on the mission statement of 2,498 foundations from 2004 to 2013, this article finds that foundations' funding-sufficiency leads to the government's strong intention for functional conformity and weak intention for behavioral conformity. The article implies that the Chinese government has eased some institutional constraints on foundations for the purpose of seeking financial contributions from foundations. It suggests that the Chinese government can adapt to the socioeconomic conditions and calculate its relations with nongovernmental organizations. [ABSTRACT FROM AUTHOR]

Sociologists have queried over the utility and effectiveness of generational analysis for some time. Here, the authors contend that intragenerational analyses are needed to critically and comprehensively make sense of the social world. Drawing on four presentations during the presidential session titled, "#NextGenBlackSoc: New Directions in the Sociology of Black Millennials," the authors use Black Millennials as a case to illustrate how racializing generational studies can strengthen sociological research in four particular subdisciplines: Collective Behavior and Social Movements, Religion, Gender and Sexuality, and Family. They ultimately argue new analytic approaches are necessary to produce significant research on individuals and groups with complex intersectional identities and the particularities of their social experiences. [ABSTRACT FROM AUTHOR]

Donor agencies and foundations use grants to stimulate entrepreneurial growth in developing countries. However, some practitioners have asked whether these grants tend to flow to expatriate entrepreneurs with ties to developed countries (where most grants originate), rather than to local entrepreneurs. This article tackles this question using a data set of 3,434 nascent ventures from 92 developing countries. The authors find that ventures with ties to a developed country are significantly more likely to raise grant financing and in more substantial amounts. Ventures with a founder born in a developed country are the most likely to receive grants, with a weaker effect when considering prior work experience in a developed country. This "expat gap" cannot be explained by differences in education level, prior experience, or ties to other developing countries. Donors seeking to support local entrepreneurs in developing countries should consider ways to make their recruitment and selection processes more equitable. [ABSTRACT FROM AUTHOR]

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