Perioperative analgesia in decreasing the incidence and or severity of phantom pain-non-randomised observational study between intravenous morphine versus intramuscular diclofenate

PURPOSEOFTHESTUDY To evaluate the perioperative intravenous morphine and intramuscular diclofenate in reducing the incidence of phantom limb pain as well as the severity of phantom pain following lower limb amputation. In addition, to evaluate the association between phantom limb pain and the pain suffered before the amputation, the duration of diabetic mellitus and the duration of various feet or legs problems prior to amputation. METHOD This was a non-randomsed observational study involving a total 55 patients. 27 patients were selected for intravenous morphine infusion. The patients' blood pressure, heart rate, respiratory rate, sedation score, blood oxygen saturation were monitored closely. The other 28 patients were selected for intramuscular diclofenate. The drug was given to those patient who had pain score at 2 or more before operation and at regular dose after amputation. The rescue intramuscular tramadol was added if the pain was not adequately controlled in diclofenate group. Both medications were continued till day-3 post-amputation. The characteristic, intensity and location of pain encountered before analgesia, after analgesia and after amputation was documented. The modified numerical pain score wasused to quantify the intensity of pain. The phantom sensation, phantom pain and stump pain following lower limb amputation was identified in both groups. The patients were followed up at one week, 1, 3 and 6 months after amputation via phone. RESULTS Patients in both groups experienced comparable pain intensity before and after the operation (p > 0.05). However, two patients in diclofenate group required rescue i/m tramadol 50 mg for post-amputation pain control. Overall, 50 out of 55 patients (90%) experienced phantom limb sensation and 33 patients (60%) encountered phantom pain after amputation. Twenty one patients (75%) out of 28 in diclofenate group had phantom limb pain compared with 12 patients ( 44%) out of 27 in morphine group. The phantom sensation in diclofenate and morphine group was 89% and 92% respectively. In 16 patients with phantom limb pain (48%), the symptom subsided within 6 months. Most of the phantom pain encountered was low pain score and only 2 patients required medical treatment. Patients in morphine group was 0.176 time (odd-ratio) less likely to develop phantom limb pain as compared to diclofenate group (p < 0.05). Intravenous morphine significantly reduced the severity of phantom limb pain after adjusting possible confounding factors like sex, age, race and presence or absence of diabetic mellitus (p < 0.05). The maximal phantom pain score in morphine and diclofenate groups was 1.57 and 2.37 respectively. The severity of pre-analgesic prun and the duration of various leg and foot problem encountered prior to amputation did not significantly relate to phantom pain. However, the the longer history of diabetic mellitus had less risk or incidence of phantom pain (p =0.03). CONCLUSION This study showed perioperative intravenous morphine infusion reduced the incidence and severity of phantom limb pain as compared to intramuscular diclofenate

A cognitive hierarchy model of games

Players in a game are “in equilibrium” if they are rational, and accurately predict other players' strategies. In many experiments, however, players are not in equilibrium. An alternative is “cognitive hierarchy” (CH) theory, where each player assumes that his strategy is the most sophisticated. The CH model has inductively defined strategic categories: step 0 players randomize; and step k thinkers best-respond, assuming that other players are distributed over step 0 through step k − 1. This model fits empirical data, and explains why equilibrium theory predicts behavior well in some games and poorly in others. An average of 1.5 steps fits data from many games

Fairness of performance evaluation procedures and job satisfaction: the role of outcome-based and non-outcome based effects

Prior management accounting studies on fairness perceptions have overlooked two important issues. First, no prior management accounting studies have investigated how procedural fairness, by itself, affects managers' job satisfaction. Second, management accounting researchers have not demonstrated how conflicting theories on procedural fairness can be integrated and explained in a coherent manner. Our model proposes that fairness of procedures for performance evaluation affects job satisfaction through two distinct processes. The first is out-come-based through fairness of outcomes (distributive fairness). The second is non-outcome-based through trust in superior and organisational commitment. Based on a sample of 110 managers, the results indicate that while procedural fairness perceptions affect job satisfaction through both processes, the non-outcome-based process is much stronger than the outcome-based process. These results may be used to develop a unified theory on procedural fairness effects

A cognitive hierarchy theory of one-shot games: Some preliminary results

Strategic thinking, best-response, and mutual consistency (equilibrium) are three key modelling principles in noncooperative game theory. This paper relaxes mutual consistency to predict how players are likely to behave in in one-shot games before they can learn to equilibrate. We introduce a one-parameter cognitive hierarchy (CH) model to predict behavior in one-shot games, and initial conditions in repeated games. The CH approach assumes that players use k steps of reasoning with frequency f (k). Zero-step players randomize. Players using k (≥ 1) steps best respond given partially rational expectations about what players doing 0 through k - 1 steps actually choose. A simple axiom which expresses the intuition that steps of thinking are increasingly constrained by working memory, implies that f (k) has a Poisson distribution (characterized by a mean number of thinking steps τ ). The CH model converges to dominance-solvable equilibria when τ is large, predicts monotonic entry in binary entry games for τ < 1:25, and predicts effects of group size which are not predicted by Nash equilibrium. Best-fitting values of τ have an interquartile range of (.98,2.40) and a median of 1.65 across 80 experimental samples of matrix games, entry games, mixed-equilibrium games, and dominance-solvable p-beauty contests. The CH model also has economic value because subjects would have raised their earnings substantially if they had best-responded to model forecasts instead of making the choices they did

Total Productive Maintenance Strategy In A Semiconductor Manufacturer: A Case Study

The role of maintenance in manufacturing has become more crucial and important in today’s competitive environment. It is estimated that maintenance cost contributed approximately 10-30 percent of total operation cost. In order to stay competitive, manufacturing companies are forced to introduce production improvement programs to increase both quality and productivity. Total productive maintenance (TPM) is a well-known and very useful methodology which allows manufacturing firms to attain near ideal conditions with zero downtime, zero defects and zero accident. The objective of this paper is to study the effectiveness of TPM implementation in a multinational semiconductor manufacturer. In this study a bottleneck process from the production line was chosen and continuous improvements were implemented to improve equipment effectiveness. The results achieved are very encouraging in the reduction of equipment downtime, improvement in overall equipment effectiveness, employee motivation and reduction in number of accidence rate at the shop-floor

Models of thinking, learning, and teaching in games

Noncooperative game theory combines strategic thinking, best-response, and mutual consistency of beliefs and choices (equilibrium). Hundreds of experiments show that in actual behavior these three forces are limited, even when subjects are highly motivated and analytically skilled (Camerer, 2003). The challenge is to create models that are as general, precise, and parsimonious as equilibrium, but which also use cognitive details to explain experimental evidence more accurately and to predict new regularities. This paper describes three exemplar models of behavior in one-shot games (thinking), learning over time, and how repeated “partner” matching affects behavior (teaching) (see Camerer et al., 2002b)

Simulation of mixed-load testing process in an electronic manufacturing company

The automatic testing machine, called by mixed-load tester, has ability to load and test multiple product families in different testing durations simultaneously. However, the high product mixes for each product family undergoes a different process flow. In addition, the capability of the robot inside tester used for loading and unloading a product to each slot makes the capacity planning problem more complicated. It effects low tester utilization. This paper developed simulation models of capacity planning scenarios under demand and testing time uncertainty. These scenarios are built by robust optimization to handle worst case condition. The result shows the proposed solutions gives better tester utilization and improves the decision making process by providing more detailed and precise information about capacity planning under uncertainties that was not available in company`s current method. To the best of our knowledge, this developed model is the first one considering the mixed–load tester under uncertainties