We read with interest the recent paper published by Khusid et al (1), highlighting the effects of the COVID-19 pandemic on resident well-being and educational outcomes. We too have sensed the urgent need for adapting clinical, educational and scientific practice to appropriately attend to the public health crisis. As stated by the authors (1), significant changes have been reported in the structure of academic centers with an important impact on the daily practice of health professionals including resident physicians. Accordingly, teaching hospitals have cancelled academic meetings and many clinicians and investigators may consider it not feasible to follow the rigorous procedures set by research regulation in order to carry out research activities in the context of the pandemic (2).
  This study assessed the effects of an acute stress model upon the long-term hyperalgesia induced by repeated morphine administration in neonatal rats. We also evaluated neurotrophins and cytokines levels; expressions of adenosine and acetylcholine receptors, and acetylcholinesterase enzyme at the spinal cord.
 
  Male Wistar rats were subjected to morphine or saline administration from P8 to P14. Thermal hyperalgesia and mechanical hyperesthesia were assessed using the hot plate (HP) and von Frey (vF) tests, respectively, at postnatal day P30 and P60. After baseline measurements, rats were subjected to a single exercise session, as an acute stress model, at P30 or P60. We measured the levels of BDNF and NGF, interleukin-6, and IL-10 in the cerebral cortex and the brainstem; and the expression levels of adenosine and muscarinic receptors, as well as acetylcholinesterase (AChE) enzyme at the spinal cord.
 
  A stress exercise session was not able to revert the morphine-induced hyperalgesia. The morphine and exercise association in rats induced a decrease in the neurotrophins brainstem levels, and A
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  receptors expression in the spinal cord, and an increase in the IL-6 cortical levels. The exercise reduced M2 receptors expression in the spinal cord of naive rats, while morphine prevented this effect.
 
  Single session of exercise does not revert hyperalgesia induced by morphine in rats; however, morphine plus exercise modulate neurotrophins, IL-6 central levels, and expression of adenosine receptors.
 Single session of exercise does not revert hyperalgesia induced by morphine in rats; however, morphine plus exercise modulate neurotrophins, IL-6 central levels, and expression of adenosine receptors.
  Rising numbers of older people with obesity living in care homes is an international phenomenon. Addressing dietary management of residents with obesity is a cause of debate and controversy. On one hand, the 'obesity paradox' suggests obesity protects against morbidity in frail older people. On the other hand, obesity reduces functional status and restricts activity for this group. This paper considers care home staff's experience and views of supporting dietary management and choice for residents with obesity within the context of this controversy.
 
  In this qualitative study, 33 staff from seven care homes in the North East England participated in focus groups, and data were analysed using Braun and Clarkes's (2006) six-phase thematic analysis approach.
 
  Findings indicate that participants' support of dietary management and choice for residents with obesity may be strongly influenced by the care home environment. Care priorities, dietary management approaches, care home life and family involvement in residents' dietary intake facilitate and encourage weight gain, and as such, pose challenges for staff attempting to support weight management of residents with obesity.
 
  Findings suggest that in the care home setting, nutrition policy, guidelines and service commissioning processes and staff nutrition education should include management of obesity.  https://www.selleckchem.com/products/ipi-549.html  Furthermore, families should be supported to understand the implications of their own caring behaviours on residents' nutritional status.
 Findings suggest that in the care home setting, nutrition policy, guidelines and service commissioning processes and staff nutrition education should include management of obesity. Furthermore, families should be supported to understand the implications of their own caring behaviours on residents' nutritional status.
  Acute pain events are a leading complication for sickle cell patients. In an attempt to improve pain outcomes, we developed an outpatient pain clinic, and included intranasal fentanyl in the opioid emergency department (ED) pain order set. We evaluated admission rates and opioid administration for patients that attended both the outpatient pain clinic and ED within a 3-month period.
 
  We recorded the admission rate, IV morphine equivalents, and time from triage for each opioid order and administration from both an outpatient pain clinic and ED visit within a 3-month period for an individual pediatric patient with sickle cell disease.
 
  Thirty patients received acute pain management in both settings. We identified a significant reduction in hospital admission when patients received care in the pain clinic as compared to the ED (17% vs 43%, P=.02). Additionally, outpatient pain clinic patients received significantly less IV morphine equivalents than patients received in the ED (5.6 vs 10.6 IV morphine equivalents, P<.0001). In the ED, intranasal fentanyl was administered in a significantly shorter time than patients ordered intravenous opioid (43 vs 75min, P=.02). The mean time to receiving an opioid in the outpatient pain clinic was 57min.
 
  The use of an outpatient pain clinic can reduce admission rates as compared to the ED. The use of intranasal fentanyl reduced the time to first opioid administration in the ED. Patient-centered research or quality improvement projects should continue to focus on novel approaches to acute pain event management.
 The use of an outpatient pain clinic can reduce admission rates as compared to the ED. The use of intranasal fentanyl reduced the time to first opioid administration in the ED. Patient-centered research or quality improvement projects should continue to focus on novel approaches to acute pain event management.