There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. The authors investigated the association of patient ...characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain 3 months postsurgery. The authors hypothesized that patient characteristics and intraoperative factors predict opioid consumption and pain 3 months postsurgery.
Eleven U.S. and one European institution enrolled patients scheduled for spine, open thoracic, knee, hip, or abdominal surgery, or mastectomy, in this multicenter, prospective observational study. Preoperative and postoperative data were collected using patient surveys and electronic medical records. Intraoperative data were collected from the Multicenter Perioperative Outcomes Group database. The association between postoperative opioid consumption and surgical site pain at 3 months, elicited from a telephone survey conducted at 3 months postoperatively, and demographics, psychosocial scores, pain scores, pain management, and case characteristics, was analyzed.
Between September and October 2017, 3,505 surgical procedures met inclusion criteria. A total of 1,093 cases were included; 413 patients were lost to follow-up, leaving 680 (64%) for outcome analysis. Preoperatively, 135 (20%) patients were taking opioids. Three months postsurgery, 96 (14%) patients were taking opioids, including 23 patients (4%) who had not taken opioids preoperatively. A total of 177 patients (27%) reported surgical site pain, including 45 (13%) patients who had not reported pain preoperatively. The adjusted odds ratio for 3-month opioid use was 18.6 (credible interval, 10.3 to 34.5) for patients who had taken opioids preoperatively. The adjusted odds ratio for 3-month surgical site pain was 2.58 (1.45 to 4.4), 4.1 (1.73 to 8.9), and 2.75 (1.39 to 5.0) for patients who had site pain preoperatively, knee replacement, or spine surgery, respectively.
Preoperative opioid use was the strongest predictor of opioid use 3 months postsurgery. None of the other variables showed clinically significant association with opioid use at 3 months after surgery.
Abstract Objectives The objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria. Methods In ...this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy. Results The children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. The delay between aspiration and removal was 2–8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of vesicular murmur. The examination was normal in 13%. The most common radiologic finding was pulmonary air trapping (40.7%). The aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. The endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. The complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%. Conclusion Foreign body aspiration is a real public health problem in Algeria. The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff. The prevention of this domestic accident should consider the population lifestyle and cultural habits to be more effective.
To study the impact of anesthesia opioid-related outcomes and acute and chronic postsurgical pain, we organized a multicenter study that comprehensively combined detailed perioperative data elements ...from multiple institutions. By combining pre- and postoperative patient-reported outcomes with automatically extracted high-resolution intraoperative data obtained through the Multicenter Perioperative Outcomes Group (MPOG), the authors sought to describe the impact of patient characteristics, preoperative psychological factors, surgical procedure, anesthetic course, postoperative pain management, and postdischarge pain management on postdischarge pain profiles and opioid consumption patterns. This study is unique in that it utilized multicenter prospective data collection using a digital case report form integrated with the MPOG framework and database. Therefore, the study serves as a model for future studies using this innovative method. Full results will be reported in future articles; the purpose of this article is to describe the methods of this study.
Vertebrate microfossil bonebeds (VMBs)—localized concentrations of small resilient vertebrate hard parts—are commonly studied to recover otherwise rarely found small-bodied taxa, and to document ...relative taxonomic abundance and species richness in ancient vertebrate communities. Analyses of taphonomic comparability among VMBs have often found significant differences in size and shape distributions, and thus considered them to be non-isotaphonomic. Such outcomes of “strict” statistical tests of isotaphonomy suggest discouraging limits on the potential for broad, comparative paleoecological reconstruction using VMBs. Yet it is not surprising that sensitive statistical tests highlight variations among VMB sites, especially given the general lack of clarity with regard to the definition of “strict” isotaphonomic comparability. We rigorously sampled and compared six VMB localities representing two distinct paleoenvironments (channel and pond/lake) of the Upper Cretaceous Judith River Formation to evaluate biases related to sampling strategies and depositional context. Few defining distinctions in bioclast size and shape are evident in surface collections, and most site-to-site comparisons of sieved collections are indistinguishable (p≤ 0.003). These results provide a strong case for taphonomic equivalence among the majority of Judith River VMBs, and bode well for future studies of paleoecology, particularly in relation to investigations of faunal membership and community structure in Late Cretaceous wetland ecosystems. The taphonomic comparability of pond/lake and channel-hosted VMBs in the Judith River Formation is also consistent with a formative model that contends that channel-hosted VMBs were reworked from pre-existing pond/lake assemblages, and thus share taphonomic history.
BACKGROUND:The purpose of this study was to evaluate breast tissue expanders with magnetic ports for safety in patients undergoing abdominal/pelvic magnetic resonance angiography before autologous ...breast reconstruction.
METHODS:Magnetic resonance angiography of the abdomen and pelvis at 1.5 T was performed in 71 patients in prone position with tissue expanders with magnetic ports labeled “MR Unsafe” from July of 2012 to May of 2014. Patients were monitored during magnetic resonance angiography for tissue expander–related symptoms, and the chest wall tissue adjacent to the tissue expander was examined for injury at the time of tissue expander removal for breast reconstruction. Retrospective review of these patients’ clinical records was performed. T2-weighted fast spin echo, steady-state free precession and gadolinium-enhanced spoiled gradient echo sequences were assessed for image artifacts.
RESULTS:No patient had tissue expander or magnetic port migration during the magnetic resonance examination and none reported pain during scanning. On tissue expander removal (71 patients, 112 implants), the surgeons reported no evidence of tissue damage, and there were no operative complications at those sites of breast reconstruction.
CONCLUSION:Magnetic resonance angiography of the abdomen and pelvis in patients with certain breast tissue expanders containing magnetic ports can be performed safely at 1.5 T for pre–autologous flap breast reconstruction perforator vessel mapping.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.
The Indian Ocean Nodule Field (IONF) is significant from several points of view. Roughly bordered by 10°S to 16°30′S and 72°E to 80°E and located within the Central Indian Ocean Basin (CIOB), the ...field hosts the world's second largest and second high grade manganese nodule deposit, after the equatorial nodule belt in the north Pacific Ocean. Moreover, the crust underlying this field is characterised by unique morphotectonic signatures owing to its formation between 60 and 49 Ma under three variable spreading conditions, fast, intermediate and slow, from the Indian Ocean Ridge System (IORS).
The nodule field has been surveyed both extensively (more than 0.4 million km
2 area) and intensively (comprising of a large geophysical data set and geological sample inventory) during the last two decades. Several morphotectonic features, such as seamounts, hills, ridge-normal lineaments and ridge-parallel lineations, have disturbed the apparently smooth topographic gradient (1:7000) of the seafloor here.
Variations in the rate of spreading and formation of new oceanic crust along the ridge crest, during more than one episode of India–Eurasia collision, are imprinted in the IONF. Based on the nature of the ridge-parallel lineations, which are related to the rate of crustal accretion, the field is divided in to four sectors: A, B, C, and D, from north to south. Sectors A and C were formed at a fast rate of spreading (90–95 mm/year, half-rate) and sectors B and D were formed at an intermediate (55 mm/year) and slow (26 mm/year) rates, respectively. The predominance of tensional stress in sectors A and C caused asymmetrical flexuring of the seafloor, resulting in widely spaced faults and folds with low amplitude and large wavelength. In contrast, the seafloor flexuring in sector D are closely spaced, long, symmetrical and of high amplitude. The timing and intensity of the collision of India with Eurasia is constrained by the variable intensity of these flexures, suggesting probably a ‘soft’ touch at ∼58 Ma and the hard collision at about 51 Ma.
The nodule field hosts several seamounts, both as isolated entities and in linear chains, which are arranged parallel to the flow lines along the direction of absolute motion of the Indian plate. The distribution, morphology and growth patterns of a majority of these seamounts are related to spreading rate, suggesting their formation at the ridge crest. However, many of the seamounts show more than one stage of growth with local intraplate volcanism contributing to the enlargement of the larger ancient seamounts. Varieties of volcanics, such as tholeiitic basalts, spilites, ferrobasalts and pumice, occur within the IONF. The alteration of some of these volcanics has resulted in palagonitisation of the glass and formation of zeolites.
Subsequently, during its journey away from the ridge crest to the abyssal areas, the crust underlying the nodule field witnessed intraplate volcanism. This is evident from the addition of younger rocks at the base of the ancient seamounts, inconsistent growth of volcanoes, eruption of ferrobasalt corresponding to the areas of high amplitude magnetic zones and presence of volcanogenic–hydrothermal materials (vhm) of 10 ka age. These findings collectively hint that the IONF is geodynamically unstable and may have been volcanically active in the recent past.
During the last 8 Ma, growth of authigenic ferromanganese deposits in the form of manganese nodules and crusts has occurred in the nodule field. The deposits occur at an average water depth of 5000 m. The basinal geomorphology, intraplate tectonic deformations and volcanic eruptions considerably influence the formation, development, morphology, mineralogy and composition of these deposits. The data show that the large seamounts, reverse faults and fracture zones (FZs) supply rock fragments as ‘seeds’ for the nodule formation. The hydrogenous precipitation from the overlying water column is the primary source of metal accumulation in the nodules. The secondary (relatively weak) intraplate eruptions along the base of ancient seamounts or lineaments, subsurface igneous activity and diagenetic remobilisation of metals have also played significant role in the growth and enrichment of the deposit.
Based on a large data set, we estimate the contribution of various physico-chemical parameters and model the probable conditions of formation of the ferromanganese deposits in the IONF. The model also hints at the location where the resource exploitation should be rewarding.
A Simple Tele-robotic Lunar Excavator Rhaman, M. K.; Hasan, S. I.; Hossain, M. J. ...
2012 International Conference on Advanced Computer Science Applications and Technologies (ACSAT),
2012-Nov.
Conference Proceeding
An excavation tele-robotic system is developed to excavate and collect lunar regolith. The excavator has been developed by the team BRACU ChondroBot consisting students from BRAC University for ...NASA's 2nd Annual Lunabotics Mining Competition (LMC) 2011. Considering the requirement of NASA and calculating the load, friction and power the mechanical excavator was designed and built. The dimension of the excavator is 1.45m × .74m × 1.48m and the weight is 80 kg. It consists of two excavation arm and one pulley system depositor bucket. Two conveyer belt type wheels are used to drive the robot. Efficient control and communication is always a big challenge for a Tele-robot. In our developed system hardware can be operated both manually and remotely through a web browser by logging in from any computer without direct visual and auditory access to the hardware. A unique control circuit, graphical user interface and communication module for two terminals are also developed for remote access.
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