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Background Opioid medications are commonly used to treat chronic pain around the world. While these medications are quite effective at reducing pain, they can create opioid dependence and lead to further drug addiction. Long-term opioid use has significantly contributed to the “opioid epidemic” that is currently ravaging the United States, leading to opioid overdoses and unintentional deaths, particularly in Delaware. Objective To determine if medical marijuana certification helps patients in Delaware with chronic pain reduce their opiate use. Methods In this study, we examined individuals who were provided with legal; medical cannabis certifications in the state of Delaware between June 2018 and October 2019 and were concurrently being treated with opioid medications for chronic pain at a private pain management practice. Using a posthoc analysis, we conducted a retrospective cohort study on the individuals (n = 81) to determine if there was a decrease in their opioid use following medical cannabis certification. Opioid use was measured in morphine milligram equivalent (MME) through the Delaware prescription monitoring program (PMP) database. Results Overall, the average change in prescribed opioid use was found to be -12.3 morphine milligram equivalent (MME) units when including all individuals (p < 0.00001). Among the included individuals with baseline opioid use, medical cannabis certification was associated with a 31.3% average decrease in opioid use (n = 63). When examining subgroups based upon pain location, individuals with neck pain displayed a 41.5% average decrease in MME (n = 27), while individuals with low back pain were observed to have a 29.4% decrease in opioid use (n = 58). Similarly, individuals with knee pain (n = 14) reduced their opioid use by 32.6%. Conclusion The results display an association between medical cannabis certification and a decrease in opiate use among the study group individuals. This study suggests that medical cannabis use may help individuals to reduce their opiate requirements along with physician intervention. More research is needed to validate these findings with appropriate controls and verification of cannabis use.

The brain demands a significant fraction of the energy budget in an organism; in humans, it accounts for 2% of the body mass, but utilizes 20% of the total energy metabolized. This is due to the large load required for information processing; spiking demands from neurons are high but are a key component to understanding brain functioning. Astrocytic brain cells contribute to the healthy functioning of brain circuits by mediating neuronal network energy and facilitating the formation and stabilization of synaptic connectivity. During development, spontaneous activity influences synaptic formation, shaping brain circuit construction, and adverse astrocyte mutations can lead to pathological processes impacting cognitive impairment due to inefficiencies in network spiking activity. We have developed a measure that quantifies information stability within in vitro networks consisting of mixed neural-astrocyte cells. Brain cells were harvested from mice with mutations to a gene associated with the strongest known genetic risk factor for Alzheimer's disease, APOE. We calculate energy states of the networks and using these states, we present an entropy-based measure to assess changes in information stability over time. We show that during development, stability profiles of spontaneous network activity are modified by exogenous astrocytes and that network stability, in terms of the rate of change of entropy, is allele dependent.

Popular professional online networking sites, such as LinkedIn™, Monster™, CareerBuilder®, and others, focus on traditional jobs. Increasing demand for high school internships suggests an interest for an electronic networking database pertinent to high school opportunities [14]. In comparison to traditional methods of acquiring internships, such a database would provide increased accessibility and efficiency through an HCI conceptualized computer interface. Surveys were designed and distributed to stakeholders, an east coast, chartered high school (students grades 9–12, n = 132), businesses (n = 18), and parents (n = 143), to gather reactionary information. A Kruskal-Wallis, nonparametric algorithm found significant differences (p < 0.05) amongst the variables and eliminated errors due to a lack of homoscedasticity. The data found desirability, optimal implementation, and privacy concerns across independent variables. The degree that all stakeholders will feel comfortable in using a database to focus internship potential revolves about the efficacy, presentation, and portal attributes of the database.

Background: We hypothesize that being an editorial board member (EBM) in a high impact factor specialty medical journal increases the chances of publishing in the same journal. Materials and Methods: The publication trends of the first five EBMs in the five highest impact factor Anesthesiology and Gastroenterology journals were analyzed. Preceding 5 years' publications appearing on PubMed were grouped into as follows: number of publications in the journal in which the EBM serves (N1), number of publications by the same author in the other four highest impact factor (IF) journals (N2) and number of publications in all the other journals (N3). We evaluated the probability of the observed distribution of publications in the five highest IF journals happening by chance alone, assuming that all the EBMs had the same opportunity of publishing in any of these journals. The probability of publishing in their own journal was assumed to be one fifth. Results: The EBMs published their manuscripts in their own journal at a very high frequency. Encompassing all ten journals, the calculated P value for such a distribution was

Background: In this meta-analysis, we explore the role of repetitive transcranial magnetic stimulation (rTMS), a noninvasive neuromodulation technique in the treatment of chronic pain. Methods: Studies comparing rTMS and conventional treatment for chronic pain were searched. The comparison was made for decrease in the pain scores with and without (sham) the use of rTMS after a follow-up interval of 4–8 weeks. All reported pain scores were converted into a common scale ranging from “0” (no pain) to “10” (worst pain). Results: Nine trials with 183 patients in each of the groups were included in the analysis. The decrease in pain scores with rTMS was 1.12 (95% confidence interval [CI] being 1.46–0.78) (fixed effects, I2 = 0%, P < 0.001) and in sham-rTMS was 0.28 (95% CI being 0.49–0.07) (Fixed effects, I2 = 0, P = 0.01). The pooled mean drop in pain scores with rTMS therapy was higher by 0.79 (95% CI being 0.26–1.33) (fixed effects, I2 = 0, P < 0.01). The duration and frequency of rTMS were highly variable across trials. Publication bias was unlikely (Egger's test, X-intercept = 0.13, P = 0.75). Conclusions: Use of rTMS improves the efficacy of conventional medical treatment in chronic pain patients. This treatment is not associated with any direct adverse effects. However, the duration and frequency of rTMS therapy is presently highly variable and needs standardization.