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The function of endogenous opioids spans from initiating behaviors that are critical for survival, to responding to rapidly changing environmental conditions. A network of interconnected systems throughout the body characterizes the endogenous opioid system (EOS). EOS receptors for beta-endorphin, enkephalin, dynorphin, and endomorphin underpin the diverse functions of the EOS across biological systems. This chapter presents a succinct yet comprehensive summary of the structure of the EOS, EOS receptors, and their relationship to other biological systems.

The perioperative management of biliary disease (BD) is variable across institutions with suboptimal outcomes for patients and health care systems. This results in inefficient utilization of limited resources. The aim of the current study was to identify modifiable factors impacting patients\' time to theater, intraoperative time, and time to discharge as the constituents of length of stay to guide creation of a perioperative management protocol to address this variability.
Data were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post, and intraoperative factors were assessed for their impact on time to theater, operative time, and postoperative hours to discharge.
Four thousand five hundred seventy-seven patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theater was significantly impacted by preoperative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Postoperatively time to discharge was significantly impacted by drain placement.
Standardizing management of BD would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intraoperative difficulty operative grade identification, and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardization of care across the patient workflow in BD is a sensible approach for ensuring optimal use of scarce resources.

Women\'s experiences of military service and transition occur within a highly dominant masculinized culture. The vast majority of research on military veterans reflects men\'s experiences and needs. Women veterans\' experiences, and therefore their transition support needs, are largely invisible. This study sought to understand the role and impact of gender in the context of the dominant masculinized culture on women veterans\' experiences of military service and transition to civilian life. In-depth qualitative interviews with 22 Australian women veterans elicited four themes: (1) Fitting in a managing identity with the military; (2) Gender-based challenges in conforming to a masculinized culture-proving worthiness, assimilation, and survival strategies within that culture; (3) Women are valued less than men-consequences for women veterans, including misogyny, sexual harassment and assault, and system failures to recognize women\'s specific health needs and role as mothers; and (4) Separation and transition: being invisible as a woman veteran in the civilian world. Gendered military experiences can have long-term negative impacts on women veterans\' mental and physical health, relationships, and identity due to a pervasive masculinized culture in which they remain largely invisible. This can create significant gender-based barriers to services and support for women veterans during their service, and it can also impede their transition support needs.

Background: Millions of injuries and deaths occur yearly from preventable errors, despite interventions applied at the point of care. Although evidence suggests that system-level factors are responsible for hospital system health and patient safety, research has largely not accounted for hospital complexity. Prior to the authors\' research regarding the communication of system-level events that influence hospital system health and patient safety, no nursing-specific communication theories that accounted for hospital complexity were identified. However, theory-guided research holds the potential to boost scientific knowledge through the provision of a robust foundational understanding of phenomena. Purpose: The purpose of this article is to discuss the concept derivation used to create a middle-range theory for the guidance of research involving system-level communication in complex healthcare environments as it relates to hospital system health and patient safety. Methods: Concept derivation as described by Walker and Avant (2018) was conducted using parent concepts from the Effective Nurse-to-Nurse Communication Framework, Symbolic Interactionism, Information Theory, Gerbner\'s Communication Model, and Complexity Theory. Results: Authentication of the derived Effective System-to-System Communication Theory (ESSCT) was confirmed through identification of coherent relationships between the concepts and conceptual statements, alignment with the nursing metaparadigm, and peer review by a subject matter expert from the nursing discipline. Additionally, research revealed an overall congruency between the research findings and the ESSCT\'s theoretical statements. Implications: The current healthcare climate necessitates that research involving communication be optimized by a germane theoretical underpinning that accounts for hospital complexity. The authors contend that the use of the derived theory may assist such endeavors.

Behavioral science has a long history of engaging in efforts to understand and address socially important issues. Poverty and inequities in health and development are among the most important and complex social issues facing the world today. With its Sustainable Development Goals (SDGs), the United Nations (2015) has focused attention and guidance on addressing key global challenges, including to \"end poverty\" (SDG 1), \"ensure good health and well-being for all\" (SDG3), and \"reduce inequality within and among countries\" (SDG 10). In this paper, we provide a framework and illustrative examples of contributions of behavioral science to these issues. We feature illustrative behavioral interventions at the individual, relationship, community, and societal levels. We highlight the diversity of issues, intervention methods, and settings reflected in applications of behavioral science. By joining methods from behavioral science, public health, and other disciplines-and the experiential knowledge of those most affected by inequities-behavioral methods can make significant contributions to collaborative efforts to assure health and well-being for all.

The orbitofrontal cortex, one of the key neocortical areas in valuation and emotion, is critical for cognitive flexibility but its role in the consolidation of recently acquired information remains unclear. Here, we demonstrate orbitofrontal offline replay in the context of a place-reward association task on a maze with varying goal locations. When switches in place-reward coupling were applied, replay was enhanced relative to sessions with stable contingencies. Moreover, replay strength was positively correlated with the subsequent overnight change in behavioral performance. Interrogating relationships between orbitofrontal and hippocampal activity, we found that orbitofrontal and hippocampal replay could occur independently but became coordinated during a type of cortical state with strong spiking activity. These findings reveal a structured form of offline orbitofrontal ensemble activity that is correlated with cognitive flexibility required to adapt to changing task contingencies, and becomes associated with hippocampal replay only during a specific state of high cortical excitability.

Depression is one of the most common psychiatric disorders worldwide, affecting approximately 280 million people, with probably much higher unrecorded cases. Depression is associated with symptoms such as anhedonia, feelings of hopelessness, sleep disturbances, and even suicidal thoughts. Tragically, more than 700 000 people commit suicide each year. Although depression has been studied for many decades, the exact mechanisms that lead to depression are still unknown, and available treatments only help a fraction of patients. In the late 1960s, the serotonin hypothesis was published, suggesting that serotonin is the key player in depressive disorders. However, this hypothesis is being increasingly doubted as there is evidence for the influence of other neurotransmitters, such as noradrenaline, glutamate, and dopamine, as well as larger systemic causes such as altered activity in the limbic network or inflammatory processes. In this narrative review, we aim to contribute to the ongoing debate on the involvement of serotonin in depression. We will review the evolution of antidepressant treatments, systemic research on depression over the years, and future research applications that will help to bridge the gap between systemic research and neurotransmitter dynamics using biosensors. These new tools in combination with systemic applications, will in the future provide a deeper understanding of the serotonergic dynamics in depression.

OBJECTIVE: This study reconceptualized trait resilience, defining it as a network of systems; utilizing direct resilience assessments-engineering, ecological, adaptive capacity, social cohesion-and proxy resilience assessments-personality, cognitive, emotional, eudaimonia, and health.
BACKGROUND: The background of the study addresses the fragmented conceptualization of trait resilience by proposing a unifying network model based on ecological systems theory, illustrating the dynamic interplay of resilience factors across varying levels of disturbance.
METHODS: In Study One, four USA or UK samples (total n = 2396) were used to depict the trait resilience network. Study Two (n = 1091) examined the relationship between the network and disturbance at two time-points, using mental health levels as a disturbance metric.
RESULTS: Study One found that adaptive capacity, and sometimes positive emotional processes, were central variables to the network. Study Two found that in lower disturbance groups, adaptive capacity remained important, while in higher disturbance groups, a broader set of variables became central to the network.
CONCLUSIONS: Study One suggests a Broaden-and-Build approach, where adaptive capacity is a foundational resilience capability, reciprocally associated with positive emotional mechanisms. Study Two suggests a new \"Dynamic Resilience Spectrum Theory,\" proposing that increased disturbances necessitate the use of a more diverse set of resilience traits.

BACKGROUND: Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity.
METHODS: We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review.
RESULTS: Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes.
CONCLUSIONS: There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings.
UNASSIGNED: CRD42022348529 LEVEL OF EVIDENCE: Level III.