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and AimsPatients with Crohn's disease (CD) are often prescribed opioids chronically to manage pain associated with their disease. However, little evidence exists to support this practice. Here, we examine newly diagnosed patients with CD with and without chronic opioid use (COU) and sought to identify predictors and consequences of COU.MethodsA nationally representative administrative health care claims that data set identified newly diagnosed patients with CD. Their data were examined during the periods 6 months before and 2 years after diagnosis. Multivariable logistic regression was used to assess predictors of COU at diagnosis.ResultsThe final study cohort consisted of 47,164 patients with CD. Of them, 3.8% were identified with new COU. Chronic opioid users were more likely women, older, and likely who had more surgeries, endoscopies, admissions, and medication usage compared with other patients. Features detected before CD diagnosis that correlated with COU after diagnosis included previous opioid use (odds ratio [OR] = 6.6), chronic pain (OR = 1.36), arthritis (OR = 1.95), and mental disorders (OR = 1.58). Interestingly, emergency department visits before CD Dx increased the risk of COU (OR = 1.11), whereas endoscopy reduced COU risk (OR = 0.88).ConclusionsThis study presents a nationally representative assessment of COU in newly diagnosed patients with CD. The results may be used to determine the impact of COU in this population and to alert clinicians to those patients with CD at high risk of COU. Chronic opioids are consistently associated with indicators of more severe disease; however, additional research is needed to determine whether COU drives disease severity or vice versa.

INTRODUCTION:Inflammatory bowel disease (IBD) patients are chronically prescribed narcotics for chronic relapsing abdominal pain. We previously reported that emergency room (ER) visits in IBD patients increase the risk for chronic opioid use (COU - defined as 90 days of opioid use in a 6-month period) (Pauley et al Infl Bowel Dis 2017). Here we examine if referral to addiction medicine therapy reduces opioid prescriptions as well as ER visits.METHODS:IBD patients seen in the University of Kentucky out-patient GI clinic between January 2013 and November 2018 with COU were identified. Referrals to addiction medicine were identified by ICD 9/10 billing codes. EMRs of all study patients were retrospectively examined to collect data. Paired samples t-test was performed for outcomes 1 yr before and after addiction medicine consultation. All the statistical analysis was performed using SPSS Version 25 software; an alpha level of .05 was used throughout.RESULTS:During the 6-yr period, 2296 IBD patients on narcotics were identified. Among those 77 patients received addiction medicine referral, 36 patients complied. Mean age of the study population was 43 yrs. ER visits were reduced by 0.53 ± 0.24 visits in the year after consultation (mean ± SEM, 95% CI: 0.007–1.09; P < 0.04). Opioid prescriptions after addiction medicine consultation were also reduced by 0.37 ± 0.38 (P = 0.31). Substance abuse and mental health illnesses such as smoking, alcohol, illicit drug use, mood disorders and anxiety was seen in 72.2%, 22.2%, 19.4%, 27.8% and 16.7% of patients, respectively. Mean number of addiction medicine visits for tobacco and opioid abuse disorders were 2.2 and 5.3 respectively. Smoking cessation was successful in 11.5% of patients at 1 yr. However, a substantial reduction in smoking was noted in 26.9% of patients.CONCLUSION:Substance abuse and chronic opioids are factors known to be associated with worse outcomes in IBD patients. Our study shows IBD patients referred to addiction medicine service had significantly lower ER visits and trended to have fewer numbers of opioid prescriptions. Addiction medicine referrals were also successful in reducing smoking use by 27% with 11% cessation. Results reported here encourage further testing in larger sample sizes and suggest the implementation of addiction medicine professionals in the care of IBD patients.

[...]both on my own and in collaboration with very good friends and colleagues, we had more than 50 different board and card games marketed by various manufacturers, mainly Waddingtons, with sales of around 3 million in more than 20 countries.

SMOOTH SHOW. Bill Cope, technical supervisor and longtime backstage presence at the festival, said this year's show was \"much less hectic than usual.\" That's because he's worked frequently with Friday night's acts - [Patti LaBelle], Smokey Robinson and the Yellowjackets - and he's able to get them to make concessions to his game plan. He was expecting tonight to go smoothly too, since Kenny G and Peabo Bryson are coming into town with what Cope called a `package' that's played for eight nights at Radio City Music Hall. \"They're going to come in a crisp sort of fashion,\" he said. FANS FROM PHILLY. Ron and Deloris Jordan, who drove all the way from Philadelphia to attend the festival, came for the first time in 10 years. Although they are big fans of LaBelle and Robinson, they don't consider either of them jazz artists. JAZZ TRAVELERS. Bill and Evelyn Walker of Hampton have been attending the festival every year since 1988. \"It's sort of a tradition. We love live entertainment,\" Walker said.

Sarcomas are a key feature of Li-Fraumeni and related syndromes (LFS/LFL), associated with germline TP53 mutations. Current penetrance estimates for TP53 mutations are subject to significant ascertainment bias. The International Sarcoma Kindred Study is a clinic-based, prospective cohort of adult-onset sarcoma cases, without regard to family history. The entire cohort was screened for mutations in TP53 using high-resolution melting analysis and Sanger sequencing, and multiplex-ligation-dependent probe amplification and targeted massively parallel sequencing for copy number changes. Pathogenic TP53 mutations were detected in blood DNA of 20/559 sarcoma probands (3.6%); 17 were germline and 3 appeared to be somatically acquired. Of the germline carriers, one appeared to be mosaic, detectable in the tumor and blood, but not epithelial tissues. Germline mutation carriers were more likely to have multiple cancers (47% vs 15% for non-carriers, P = 3.0×10(-3)), and earlier cancer onset (33 vs 48 years, P = 1.19×10(-3)). The median survival of mutation carriers following first cancer diagnosis was not significantly different from non-carriers. Only 10/17 (59%) pedigrees met classical or Chompret criteria for LFS. In summary, germline TP53 mutations are not rare in adult patients with sarcoma, with implications for screening, surveillance, treatment and genetic counselling of carriers and family members.

Sustainable intensification is a process by which agricultural productivity is enhanced whilst also creating environmental and social benefits. We aimed to identify practices likely to deliver sustainable intensification, currently available for UK farms but not yet widely adopted. We compiled a list of 18 farm management practices with the greatest potential to deliver sustainable intensification in the UK, following a well‐developed stepwise methodology for identifying priority solutions, using a group decision‐making technique with key agricultural experts. The list of priority management practices can provide the focal point of efforts to achieve sustainable intensification of agriculture, as the UK develops post‐Brexit agricultural policy, and pursues the second Sustainable Development Goal, which aims to end hunger and promote sustainable agriculture. The practices largely reflect a technological, production‐focused view of sustainable intensification, including for example, precision farming and animal health diagnostics, with less emphasis on the social and environmental aspects of sustainability. However, they do reflect an integrated approach to farming, covering many different aspects, from business organization and planning, to soil and crop management, to landscape and nature conservation. For a subset of 10 of the priority practices, we gathered data on the level of existing uptake in English and Welsh farms through a stratified survey in seven focal regions. We find substantial existing uptake of most of the priority practices, indicating that UK farming is an innovative sector. The data identify two specific practices for which uptake is relatively low, but which some UK farmers find appealing and would consider adopting. These practices are: prediction of pest and disease outbreaks, especially for livestock farms; staff training on environmental issues, especially on arable farms. We identify 18 practices with the greatest potential to deliver “sustainable intensification” in UK agriculture. The practices reflect an integrated approach to sustainable intensification, with a strong focus on technology. Data on uptake of 10 of the practices, from a survey of 243 English and Welsh farms, show that many are more widely adopted than expected, reflecting an innovative UK farming industry. We recommend two practices—predicting pests and diseases in livestock farms, and environmental training for arable farm staff—become the focus of efforts to enable sustainable intensification, as these are appealing to farmers, but not so widely practiced already.

NEW ORLEANS, March 29 -- A television news commentary about Patrick Ewing aired on Saturday night apparently helped lead to Georgetown Coach John Thompson's revelation on Sunday that the freshman center had been the object of a telephoned death threat March 8, according to Georgetown sources.