Comparing the cumulative pain patients experience waiting for knee arthroplasty to their postoperative pain

Introduction: Reduction of pain is a major goal of anesthesiologists treating patients undergoing knee arthroplasty. This has been achieved traditionally through the use of regional analgesia. Although these techniques decrease postoperative pain, they inherently do not affect the longstanding pain patients experience as they wait for surgery. Our objectives were to quantify: 1) the decrease in pain achieved by surgical joint replacement; and 2) the decrease in postoperative pain achievable through femoral nerve blocks versus opioids. From a systems-based perspective, we wanted to determine how much reduction in waiting time before surgery would be necessary to achieve an equal cumulative pain decrease (i.e, pain x duration of pain) as that afforded by regional techniques in the immediate postoperative period. Materials and methods: A systematic review using PubMed was performed to obtain: 1) articles reporting preoperative pain scores for patients awaiting joint arthroplasty; 2) articles with knee arthroplasty patients who received femoral nerve blocks; and 3) articles providing duration on joint arthroplasty waiting lists. Cumulative pain was assessed by the area under the response curve of pain scores vs. time, a methodology that is simple and valid. This was calculated by multiplying mean pain scores by the duration of pain. Results: The decrease in knee pain subsequent to arthroplasty (6.4/10 vs. 2.9/10) is similar to the decrease in pain afforded by femoral nerve blocks for knee arthroplasty (4.7/10 vs. 2.0/10). Waiting times in many countries exceed 3 months. A decrease in waiting time by about 2 days results in a decrease in the area under the curve of Conclusion: Reducing waiting time for knee arthroplasty decreases total pain experienced by patients and is one systems-based approach that anesthesiologists could take to relieve pain. Further studies are needed to evaluate how best to accomplish this goal

Cities and the Environment: Eight Years of Urban Ecology Research and Practice

Since its inception, Cities and the Environment has sought to showcase a broad range of urban environmental research and practice. Thus, as we celebrate the closing of our eighth anniversary, the purpose of this paper is to remind (or, for some, introduce) researchers and practitioners of the aims and scope of the journal by describing the first eight years of its history, and to outline our vision for the next eight years

The Submillimeter Bump in Sgr A* from Relativistic MHD Simulations

Recent high resolution observations of the Galactic center black hole allow for direct comparison with accretion disk simulations. We compare two-temperature synchrotron emission models from three dimensional, general relativistic magnetohydrodynamic simulations to millimeter observations of Sgr A*. Fits to very long baseline interferometry and spectral index measurements disfavor the monochromatic face-on black hole shadow models from our previous work. Inclination angles \le 20 degrees are ruled out to 3 \sigma. We estimate the inclination and position angles of the black hole, as well as the electron temperature of the accretion flow and the accretion rate, to be i=50+35-15 degrees, \xi=-23+97-22 degrees, T_e=(5.4 +/- 3.0)x10^10 K and Mdot=(5+15-2)x10^-9 M_sun / yr respectively, with 90% confidence. The black hole shadow is unobscured in all best fit models, and may be detected by observations on baselines between Chile and California, Arizona or Mexico at 1.3mm or .87mm either through direct sampling of the visibility amplitude or using closure phase information. Millimeter flaring behavior consistent with the observations is present in all viable models, and is caused by magnetic turbulence in the inner radii of the accretion flow. The variability at optically thin frequencies is strongly correlated with that in the accretion rate. The simulations provide a universal picture of the 1.3mm emission region as a small region near the midplane in the inner radii of the accretion flow, which is roughly isothermal and has \nu/\nu_c ~ 1-20, where \nu_c is the critical frequency for thermal synchrotron emission.Comment: 14 pages, 17 figures, accepted by Ap

Tree Canopy Change in Coastal Los Angeles, 2009 - 2014

Los Angeles, California is prone to extreme climate events—e.g. drought, wildfires, and floods—that are only expected to increase with climate change. The establishment of green infrastructure, including a stable urban forest, is a strategy to improve resilience not only to these events, but also to contribute to other environmental, social, and economic goals. To this end, cities throughout Los Angeles County have tree planting programs and policies aimed to grow and maintain their urban forests. Despite the policy objectives and management goals of such programs, we know surprisingly little about the spatial distribution of the existing urban forest, how and where the canopy has changed over time, or the composition of the population living in places of canopy change. To examine these questions, we conducted an analysis of the Los Angeles Coast based on land cover data derived from high-resolution aerial imagery and LiDAR. In addition to characterizing the overall percentages of existing and possible tree canopy in 2014, we also characterized the change in tree canopy from 2009 to 2014 with five measures of tree canopy and change: total canopy, persistence, loss, gain, and net change. We used market segmentation data to analyze the relationship between tree canopy and the composition of communities. Results indicated that tree canopy covered about 15% of coastal Los Angeles, but this cover was unevenly distributed throughout the study area. The parcel-level analysis of change indicated that while the canopy did not change much from 2009-2014, the changes that did occur were localized and would have been missed at a coarser scale of analysis. Using geodemographic segments, we found that higher-income lifestyle groups tended to have more tree canopy and less loss over time. Change within land uses was consistent with overall change. These high-resolution, high-accuracy data and analyses can support valuable tools to guide decision-making about urban forests, especially as it relates to social equity

Solar-Powered Coin-Operated Mobile Charging Station for Sustainable Energy Access and Resilience

This study centers on the creation of a cutting-edge coin-operated mobile gadget charging station, harnessing the inexhaustible power of solar energy via an integrated storage battery. The primary objective is to champion solar energy as a sustainable off-grid power source with boundless growth potential. Moreover, this innovative solution extends its utility to the commercial realm, where users can access it for a nominal fee, ensuring their mobile gadgets remain charged for specified periods. In addition to its commercial viability, this charging station also serves as a crucial lifeline during unforeseen calamities and prolonged power outages, offering an essential emergency charging station. Its self-sufficient design allows it to continually charge mobile devices in the presence of sunlight. Whether it's day or night, the coin-operated mobile gadget charging station stands ready to power up small electronics and mobile devices, ensuring uninterrupted connectivity

Defining the Essential Function of Yeast Hsf1 Reveals a Compact Transcriptional Program for Maintaining Eukaryotic Proteostasis

Despite its eponymous association with the heat shock response, yeast heat shock factor 1 (Hsf1) is essential even at low temperatures. Here we show that engineered nuclear export of Hsf1 results in cytotoxicity associated with massive protein aggregation. Genome-wide analysis revealed that Hsf1 nuclear export immediately decreased basal transcription and mRNA expression of 18 genes, which predominately encode chaperones. Strikingly, rescuing basal expression of Hsp70 and Hsp90 chaperones enabled robust cell growth in the complete absence of Hsf1. With the exception of chaperone gene induction, the vast majority of the heat shock response was Hsf1 independent. By comparative analysis of mammalian cell lines, we found that only heat shock-induced but not basal expression of chaperones is dependent on the mammalian Hsf1 homolog (HSF1). Our work reveals that yeast chaperone gene expression is an essential housekeeping mechanism and provides a roadmap for defining the function of HSF1 as a driver of oncogenesis

The thermodynamic properties and phase relations of some minerals in the system CaO-AI2O3-SiO2-H2O

The heat capacities of lawsonite, margante, prehnite and zoisite have been measured from 5 to 350 K with an adiabatic-shield calorimeter and from 320 to 999.9 K with a differential-scanning calorimeter. At 298.15 K, their heat capacities, corrected to end-member compositions, are 66.35, 77.30, 79.13 and 83.84 cal K-1 mol-1; their entropies are 54.98, 63.01, 69.97 and 70.71 cal K-1 mol-1, respectively. Their high-temperature heat capacities are described by the following equations (in calories, K, mol): Lawsonite (298-600 K): Cp[deg] = 66.28 + 55.95 x 10-3T - 15.27 x 105 T-2 Margarite (298-1000 K): Cp[deg] = 101.83 + 24.17 x 10-3T - 30.24 x 105 T-2 Prehnite (298-800 K): Cp[deg] = 97.04 + 29.99 x 10-3 T - 25.02 x 105 T-2 Zoisite (298-730 K): Cp[deg] = 98.92 + 36.36 x 10-3 T - 24.08 x 105 T-2 Calculated Clapeyron slopes for univariant equilibria in the CaO-Al2O3-SiO2-H2O system compare well with experimental results in most cases. However, the reaction zoisite + QUARTZ = anorthite + grossular + H2O and some reactions involving prehnite or margarite show disagreements between the experimentally determined and the calculated slopes which may possibly be due to disorder in experimental run products. A phase diagram, calculated from the measured thermodynamic values in conjunction with selected experimental results places strict limits on the stabilities of prehnite and assemblages such as prehnite + aragonite, grossular + lawsonite, grossular + quartz, zoisite + quartz, and zoisite + kyanite + quartz. The presence of this last assemblage in eclogites indicates that they were formed at moderate to high water pressure.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23356/1/0000300.pd