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"Brian, Riley"
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A “just in time” educational intervention for opioid overprescribing in dialysis access surgery
Despite widespread efforts to combat the opioid epidemic, an ongoing contributor to opioid misuse remains post-operative opioid overprescribing by residents. The goal of this study was to evaluate the impact of a low-cost, reproducible “just in time” intervention on opioid prescribing in dialysis access operations.
Standardized opioid prescribing guidelines were emailed to residents on the vascular service on the first day of the rotation. Opioid prescriptions were reviewed for four years before and one year after this intervention. Wilcoxon rank-sum test and tests of proportions were used to compare groups.
Overall, 299 patients underwent dialysis access procedures. There was a decrease in patients discharged with opioids following the intervention from 58% to 36% (p = 0.003). For patients prescribed opioids, the median quantity decreased from 90 to 45 oral morphine equivalents (p = 0.03).
This low-cost and timely learning intervention may be a useful adjunct to reduce post-operative opioid prescriptions.
•Opioid overprescribing by surgical residents contributes to opioid misuse.•Most interventions to reduce residents' opioid prescriptions are resource-intensive.•We provided a low-cost, “just in time” opioid educational intervention to residents.•After the intervention, patients discharged with opioids decreased from 58% to 36%.•After the intervention, the median quantity of prescribed opioids was cut in half.
Journal Article
Environmental Remediation with Functional Aerogels and Xerogels
Several different types of aerogels and xerogels are demonstrated as effective sorbents for the capture and/or immobilization of radionuclides and other contaminants in gaseous form [e.g., Hg(g), I2(g), Xe, Kr] as well as ionic form (e.g., Cd2+, Ce4+, Cs+, Cu2+, Fe2+, Hg2+, I−, IO3−, Kr, Pb2+, Rb+, Sr2+, 99Tc7+, U6+, Zn2+). These sorbents have unique properties, which include high specific surface areas, high pore volumes, a range of pore sizes, and functionalities that provide methods for binding radionuclides and other contaminants, generally through physisorption, chemisorption, or a combination thereof. This combination of properties and functionalities makes these types of materials ideal for use as sorbents for capturing radionuclides. The primary base materials that will be discussed in this paper include Ag0‐functionalized silica aerogels, Ag+‐impregnated aluminosilicate aerogels, Ag0‐functionalized aluminosilicate aerogels, metal‐impregnated (non‐Ag) aluminosilicate aerogels and xerogels, sulfide‐based aerogels, and carbon‐based aerogel composites. For the capture of I2(g), the materials reported herein show some of the highest iodine loadings ever reported for inorganic sorbents. For the capture of ionic species, these materials also show promise as next‐generation materials for active radionuclide remediation. This progress report describes materials fabrication, general properties, and environmental remediation applications. Functionalized aerogels and xerogels are demonstrated for use in the removal of contaminants from aqueous and gaseous streams, including species such as halides, noble gases, actinides, lanthanides, alkalis, and alkaline earths that could pose environmental and health concerns if not captured and contained properly. This paper provides a progress report of the current state of the art in this area.
Journal Article
How COVID-19 inspired surgical residents to rethink educational programs
Residents have experienced reduced operative exposure, decreased time caring for hospitalized patients, and altered rotation schedules.1 A number of studies have been published since the start of the COVID-19 pandemic regarding the effect of the crisis on residents and resident education across fields including internal medicine, emergency medicine, otolaryngology, orthopedic surgery, and general surgery.2–7 These studies have described approaches taken by programs to mitigate the pandemic’s effect on education using alternative methods of clinical and structured learning. [...]changes affected relationships with families and some residents recognized that virtual stand-ins for family presence were unsatisfactory. [...]the pandemic affected relationships between residents and faculty.
Journal Article
Nanohybrid of Silver‐MXene: A Promising Sorbent for Iodine Gas Capture from Nuclear Waste
The increasing reliance on nuclear energy as a significant low‐carbon power source necessitates effective solutions for managing radioactive emissions. This study introduces a novel application of MXene nanohybrids, specifically silver‐MXene (Ag‐Ti3C2Tx), as an effective sorbent for radioiodine off‐gas capture at an operating temperature of 150 °C. Through comprehensive material characterization, including X‐ray diffraction, scanning and transmission electron microscopies, energy‐dispersive X‐ray spectroscopy, Raman spectroscopy, thermogravimetric analysis, inductively coupled plasma optical emission spectroscopy, and gas sorption analyses, the successful loading of Ag nanoparticles onto Ti3C2Tx is confirmed and the subsequent formation of AgI upon iodine capture. The results demonstrate that Ag‐Ti3C2Tx exhibits superior iodine uptake compared to traditional silver‐based sorbents such as silver mordenite zeolite (AgZ) and silver‐functionalized silica aerogel (AgAero). The Ag‐Ti3C2Tx achieves an iodine loading of 946 mg g−1, significantly outperforming AgZ (131 mg g−1). These findings highlight the potential of Ag‐Ti3C2Tx as a highly efficient, thermally stable sorbent for radioiodine capture, and potentially addressing key limitations of existing materials. Silver‐MXene (Ag‐Ti3C2Tx) nanohybrids effectively captured iodine gas at 150 °C, with Ag nanoparticles loaded onto MXene via silver nitrate reduction. Upon exposure to iodine gas, silver iodide forms, confirming successful adsorption. Ag‐Ti3C2Tx shows superior iodine uptake (946 mg g−1) compared to conventional sorbents, demonstrating its potential as an efficient, thermally stable solution for radioiodine capture.
Journal Article
Structure and thermodynamics of calcium rare earth silicate oxyapatites, Ca2RE8(SiO4)6O2 (RE = Pr, Tb, Ho, Tm)
Calcium rare earth silicate oxyapatites, (Ca
2
RE
8
(SiO
4
)
6
O
2
), are of interest as components of glass–ceramic nuclear waste forms. To assess their long-term behavior in a geologic repository, it is essential to determine their structure and thermodynamic stability at relevant conditions. In this work, we performed detailed structural and thermodynamic investigations on Ca
2
Pr
8
(SiO
4
)
6
O
2
, Ca
2
Tb
8
(SiO
4
)
6
O
2
, Ca
2
Ho
8
(SiO
4
)
6
O
2
, and Ca
2
Tm
8
(SiO
4
)
6
O
2
by high energy synchrotron powder X-ray diffraction combined with Rietveld analysis and high temperature oxide melt drop solution calorimetry. Enthalpies of formation from constituent oxides (∆
H
f,ox
) were determined to be − 765.1 ± 22.8 kJ/mol for Ca
2
Pr
8
(SiO
4
)
6
O
2
; − 638.9 ± 20.5 kJ/mol for Ca
2
Tb
8
(SiO
4
)
6
O
2
; − 643.3 ± 10.3 kJ/mol for Ca
2
Ho
8
(SiO
4
)
6
O
2
; and − 403.2 ± 5.1 kJ/mol for Ca
2
Tm
8
(SiO
4
)
6
O
2
. These thermodynamic parameters were used in assessing the thermochemical stability of these phases in the presence of water vapor from room temperature to 600 K, as encountered in the subsurface environments of a geological repository.
Journal Article
Sol–gel synthesis of iodosodalite precursors and subsequent consolidation with a glass binder made from oxides and sol–gel routes
Radioiodine accumulates in aqueous solutions and off-gas streams during nuclear fuel reprocessing. In addition, radioiodine is highly mobile in geological environments. Most of the radioiodine can be captured during fuel reprocessing in off-gas streams using solid sorbents and scrubbing solutions. Once iodine is captured, it must be stored in a durable form for eventual disposal. Iodosodalite has been investigated as a waste form for radioiodine, however these synthesis processes often result in mixed products and iodine volatilization during consolidation. This paper proposes a novel approach to synthesizing iodosodalite utilizing a sol–gel method followed by heat treatment. This method was chosen to lower processing temperatures and improve product yield. Preliminary experiments conducted to determine the viability of this synthesis method are presented. In addition, consolidation of sol–gel derived iodosodalite with a glass binder was explored using three different methods: (1) incorporating the glass binder during gel preparation using alkoxide precursors; (2) separately preparing the glass binder using a sol–gel method; and (3) separately preparing the glass binder using a melt-quench technique. Glass-bonded iodosodalite was successfully synthesized using these novel sol–gel-based approaches.
Highlights
Iodosodalite precursors were produced with sol–gel approaches purely from alkoxides and NaI.
For B2, the NaBSi
3
O
8
glass binder was added during the sol–gel process to produce the base gel.
For B3, the NaBSi
3
O
8
glass binder was added in as alkoxides during the initial gel synthesis.
For B4, NaBSi
3
O
8
glass binders were introduced as melt-quenched or sol–gel-derived additives.
Similar iodosodalite yields for samples with melt-quench and sol–gel-derived glass binders (B4).
Journal Article
Cs3Bi2I9-hydroxyapatite composite waste forms for cesium and iodine immobilization
Perovskite-based ceramic composites were developed as potential waste form materials for immobilizing cesium (Cs) and iodine (I) with high waste loadings and chemical durability. The perovskite Cs
3
Bi
2
I
9
has high Cs (22 wt%) and I (58 wt%) content, and thus can be used as a potential host phase to immobilize these critical radionuclides. In this work, the perovskite Cs
3
Bi
2
I
9
phase was synthesized by a cost effective solution-based approach, and was embedded into a highly durable hydroxyapatite matrix by spark plasma sintering to form dense ceramic composite waste forms. The chemical durabilities of the monolithic Cs
3
Bi
2
I
9
and Cs
3
Bi
2
I
9
-hydroxyapatite composite pellets were investigated by static and semi-dynamic leaching tests, respectively. Cs and I are incongruently released from the matrix for both pure Cs
3
Bi
2
I
9
and composite structures. The normalized Cs release rate is faster than that of I, which can be explained by the difference in the strengths between Cs−I and Bi−I bonds as well as the formation of insoluble micrometer-sized BiOI precipitates. The activation energies of elemental releases based on dissolution and diffusion-controlled mechanisms are determined with significantly higher energy barriers for dissolution from the composite versus that of the monolithic Cs3Bi2I9. The ceramic-based composite waste forms exhibit excellent chemical durabilities and waste loadings, commensurate with the state-of-the-art glass-bonded perovskite composites for I and Cs immobilization.
Journal Article