A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery.

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients\u27 pain experience and opioid consumption after carpal tunnel release (CTR) surgery. METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded. RESULTS: During the day of surgery and the first day following surgery, patients in the group with counseling reported significantly fewer prescribed opioid pills consumed compared with patients in the group without counseling, while experiencing no significant difference in pain level experience. In addition, patients in the group with counseling reported a significantly lower number of total pain pills consumed over the course of the study than the group without counseling. No major adverse reactions were noted in either group. CONCLUSIONS: Preoperative opioid counseling was found to result in a significant decrease in overall opioid consumption after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures. The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods. Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating. Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal. Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates

Spectral Partitioning for Node Criticality

Finding critical nodes in a network is a significant task, highly relevant to network vulnerability and security. We consider the node criticality problem as an algebraic connectivity minimization problem where the objective is to choose nodes which minimize the algebraic connectivity of the resulting network. Previous suboptimal solutions of the problem suffer from the computational complexity associated with the implementation of a maximization consensus algorithm. In this work, we use spectral partitioning concepts introduced by Fiedler, to propose a new suboptimal solution which significantly reduces the implementation complexity. Our approach, combined with recently proposed distributed Fiedler vector calculation algorithms enable each node to decide by itself whether it is a critical node. If a single node is required then the maximization algorithm is applied on a restricted set of nodes within the network. We derive a lower bound for the achievable algebraic connectivity when nodes are removed from the network and we show through simulations that our approach leads to algebraic connectivity values close to this lower bound. Similar behaviour is exhibited by other approaches at the expense, however, of a higher implementation complexity

Combined Banzhaf & Diversity Index (CBDI) for critical node detection

Critical node discovery plays a vital role in assessing the vulnerability of a computer network to malicious attacks and failures and provides a useful tool with which one can greatly improve network security and reliability. In this paper, we propose a new metric to characterize the criticality of a node in an arbitrary computer network which we refer to as the Combined Banzhaf & Diversity Index (CBDI). The metric utilizes a diversity index which is based on the variability of a node׳s attributes relative to its neighbours and the Banzhaf power index which characterizes the degree of participation of a node in forming shortest paths. The Banzhaf power index is inspired from the theory of voting games in game theory. The proposed metric is evaluated using analysis and simulations. The criticality of nodes in a network is assessed based on the degradation in network performance achieved when these nodes are removed. We use several performance metrics to evaluate network performance including the algebraic connectivity which is a spectral metric characterizing the connectivity robustness of the network. Extensive simulations in a number of network topologies indicate that the proposed CBDI index chooses more critical nodes which, when removed, degrade network performance to a greater extent than if critical nodes based on other criticality metrics were removed

Adding the reliability on tree based topology construction algorithms for wireless sensor networks

Topology control is a technique used in wireless sensor networks to maximize energy efficiency and network lifetime. In previous literature, many tree based techniques have been proposed to save energy and increase the network lifetime. In tree based algorithms, the most promising solution is the formation of a network backbone, which serves on behalf of rest of the nodes in the network and therefore leading towards Connected Dominating Set (CDS) formulation. However, one imminent problem with all tree based solution is a compromise on network reliability. Therefore, to address reliability issues in tree based solutions, in this paper, we propose Poly3 which maintains cliques of size three in order to achieve network reliability on top of the CDS algorithm. This makes the network more robust to link removal. Our empirical and mathematical analysis reveals that Poly3 provides better reliability than algorithms of the same kind

Integrating design thinking into extreme programming

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. The increased demand for information systems drives businesses to rethink their customer needs to a greater extent and undertake innovation to compete in the marketplace. The design thinking (DT) is a human-centered methodology leads to creativity and innovation. The agile applications development such as extreme programming (XP) as a rapid application development approach tends to focus on perfecting functionality requirement and technical implementation. However, it causes significant challenges to building software/applications to meet the needs of end-user. This study integrates DT practices into XP methodology to improve the quality of software product for the end-users and enable businesses to achieve creativity and innovation. The proposed integrated DT@XP framework presents the various DT practices (empathy, define, persona, DT user stories) are adapted into XP exploration phase, prototyping and usability evaluation into XP planning phase. Our work demonstrates the applicability of DT concepts to analyze customer/user involvement in XP projects

Point Prevalence of Toxocara vitulorum in Large Ruminants Slaughtered at Multan Abattoir

The present study was conducted to determine the point prevalence of Toxocara (T.) vitulorum in buffalo and cattle slaughtered at Multan abattoir. Gastro-intestinal tracts of 94 buffaloes and 48 cattle were examined for T. vitulorum. Prevalence of T. vitulorum was 63.83 and 37.50% in buffaloes and cattle, respectively. Sex wise prevalence of T. vitulorum was recorded as 39.46% (30/76) in male and 72.72% (48/66) in female

Comparative genomics of an endophytic Pseudomonas putida isolated from mango orchard.

This is the final version of the article. Available from the publisher via the DOI in this record.We analyzed the genome sequence of an endophytic bacterial strain Pseudomonas putida TJI51 isolated from mango bark tissues. Next generation DNA sequencing and short read de novo assembly generated the 5,805,096 bp draft genome of P. putida TJI51. Out of 6,036 protein coding genes in P. putida TJI51 sequences, 4,367 (72%) were annotated with functional specifications, while the remaining encoded hypothetical proteins. Comparative genome sequence analysis revealed that the P. putida TJI51genome contains several regions, not identified in so far sequenced P. putida genomes. Some of these regions were predicted to encode enzymes, including acetylornithine deacetylase, betaine aldehyde dehydrogenase, aldehyde dehydrogenase, benzoylformate decarboxylase, hydroxyacylglutathione hydrolase, and uroporphyrinogen decarboxylase. The genome of P. putida TJI51 contained three nonribosomal peptide synthetase gene clusters. Genome sequence analysis of P. putidaTJI51 identified this bacterium as an endophytic resident. The endophytic fitness might be linked with alginate, which facilitates bacterial colonization in plant tissues. Genome sequence analysis shed light on the presence of a diverse spectrum of metabolic activities and adaptation of this isolate to various niches.This research was financially supported by the Higher Education Commission, Islamabad Pakistan

Epidemiology of substance abuse among migrants compared to native born population in primary care.

BACKGROUND AND OBJECTIVES: Research in the United States tends to indicate that immigrants from most sociogeographic regions have considerably lower substance use disorder (SUD) rates than native born individuals. We aimed to analyze the differences between immigrants and native born population regarding substance abuse and dependence. This objective was approached using data from the ARACAT cross-sectional multicenter study in primary care settings of two different Spanish regions: Aragon and Catalonia. METHODS: Three thousand six patients (1,503 immigrants randomly selected and 1,503 native born paired by age and gender) were interviewed using the Mini-International Neuropsychiatric Interview. RESULTS: Reported substance abuse and dependence were more prevalent in the native born population than in immigrants (alcohol abuse 5.1% vs. 2.6% p < .0001, alcohol dependence 3.3% vs. 2.6% n.s., other abuse 3.4% vs. .4% p < .0001, other dependence .5% vs. 4.0% p < .0001). Large differences were detected between different ethnic groups. Sociodemographic characteristics such as female gender, older age, higher level of education or stable housing (among others), were found to be protective against different SUDs. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Immigrants have lower levels of alcohol and substance abuse, however, those that do consume show higher levels of both comorbid mental disorders and problematic alcohol/substance use. It would appear to be the case that issues specific to immigrant cultures, such as extreme stigmatization of substance and alcohol use, may serve to promote social marginalization and inhibit treatment access