Composite environmental indices-a case of rickety rankings.

Composite indices have been widely used to rank the environmental performance of nations. Such environmental indices can be useful in communicating complex information as a single value and have the potential to generate political and media awareness of environmental issues. However, poorly constructed, or poorly communicated indices, can hinder efforts to identify environmental failings, and there are considerable differences in rank among existing environmental indices. Here, we provide a review of the conceptual frameworks and methodological choices used for existing environmental indices to enhance our understanding of their accuracy and applicability. In the present study, we review existing global indices according to their conceptual framework (objectives of the index and set of indicators included) and methodological choices made in their construction (e.g., weighting and aggregation). We examine how differences in conceptual frameworks and methodology may yield a more, or less, optimistic view of a country's environment. Our results indicate that (1) multidimensional environmental indices with indicators related to human health and welfare or policy are positively correlated; (2) environment-only indices are positively correlated with one another or are not correlated at all; (3) multidimensional indices and environment-only indices are negatively correlated with each other or are not correlated at all. This indicates that the conceptual frameworks and indicators included may influence a country's rank among different environmental indices. Our results highlight that, when choosing an existing environmental index-or developing a new one-it is important to assess whether the conceptual framework (and associated indicators) and methodological choices are appropriate for the phenomenon being measured and reported on. This is important because the inclusion of confounding indicators in environmental indices may provide a misleading view of the quality of a country's environment.

Case Series: Synergistic Effect of Gabapentin and Adjuvant Pregabalin in Neuropathic Pain.

Gabapentin and pregabalin both exert high affinity to the α2δ subunit of the voltage-gated calcium channels which inhibits excitatory neurotransmitter release. The synergistic mechanism was described in rats given combinations of gabapentin and pregabalin. In this case series, we described 2 cases which may illustrate the synergistic effect of gabapentin and pregabalin in treatment resistant neuropathic pain. Low dose pregabalin was added to therapeutic gabapentin to achieve appreciable pain reduction in one case and improved quality of life in another case. Further research with more enrollment and longer study duration may help elucidate the appropriate dosing and potential associated side effects.

Evaluation of Acute Postoperative Pain Management During an Injectable Opioid Shortage.

BACKGROUND: Drug product shortages, including injectable opioids, are common and have the potential to adversely affect patient care. OBJECTIVE: To evaluate the impact of an injectable opioid shortage for hospitalized adult patients in the acute postoperative setting. METHODS: A single-center, retrospective cohort study of noncritically ill hospitalized, postoperative patients requiring opioids for acute pain management was conducted. Patient cohorts were compared preshortage and postshortage for proportion of total intravenous (IV) opioids used, proportions of specific pain medications used, subjective pain scores, 30-day mortality, respiratory depression, need for opioid reversal, hospital length of stay, and opioid equivalent doses. RESULTS: A total of 275 patients were included, 130 patients in the preshortage cohort and 145 in the postshortage cohort. The proportion of total IV opioid doses was lower in the postshortage cohort versus the preshortage cohort (16.6% vs 20.5%; P < 0.01). Specific medications used were significantly different between the cohorts. The proportion of severe pain scores was lower in the postshortage cohort versus the preshortage cohort (55.6% vs 58.5%; P = 0.04). No significant differences were seen in the overall proportion of nonopioid analgesic use, 30-day mortality, respiratory depression, need for emergent opioid reversal, hospital length of stay, or opioid equivalent doses between cohorts. CONCLUSION AND RELEVANCE: In hospitalized, postoperative adults, an injectable opioid shortage was associated with significant decreases in IV opioid use and severe pain scores but no significant differences in nonopioid analgesic use, safety outcomes, or opioid equivalent doses. These results may assist clinicians in developing strategies for injectable opioid shortages and generating hypotheses for future studies.

Omiganan pentahydrochloride (MBI 226), a topical 12-amino-acid cationic peptide: spectrum of antimicrobial activity and measurements of bactericidal activity.

The activity of omiganan pentahydrochloride (formerly MBI 226; a synthetic cationic peptide) was assessed against 1,437 recent clinical bacterial isolates and 214 recent clinical yeast isolates. The omiganan was highly active, and minimal bactericidal concentrations or minimal fungicidal concentrations were either equal to or two- to fourfold higher than MICs. Kill curve experiments showed a clear pattern of bactericidal activity.