The Novel Use of Different Bupivacaine Preparations with Combined Regional Techniques for Postoperative Pain Management in Non‐Opioid Based Laparoscopic Inguinal Herniorrhaphy

Opioids are important for surgical pain control but may not be appropriate for patients with narcotic abuse histories or opioid intolerance. We describe a laparoscopic bilateral inguinal herniorrhaphy performed without perioperative or postoperative narcotics. Postoperative analgesia involves a novel technique using 2 different bupivacaine formulations that act synergistically to avoid lag time and provide extended pain relief during the acute surgical recovery phase

Angles of Arc-Polygons and Lombardi Drawings of Cacti

We characterize the triples of interior angles that are possible in non-self-crossing triangles with circular-arc sides, and we prove that a given cyclic sequence of angles can be realized by a non-self-crossing polygon with circular-arc sides whenever all angles are at most pi. As a consequence of these results, we prove that every cactus has a planar Lombardi drawing (a drawing with edges depicted as circular arcs, meeting at equal angles at each vertex) for its natural embedding in which every cycle of the cactus is a face of the drawing. However, there exist planar embeddings of cacti that do not have planar Lombardi drawings.Comment: 12 pages, 8 figures. To be published in Proc. 33rd Canadian Conference on Computational Geometry, 202

Efficacy of Local Anesthetic With Dexamethasone on the Quality of Recovery Following Total Extraperitoneal Bilateral Inguinal Hernia Repair A Randomized Clinical Trial

Importance Quality of recovery (directly associated with patient satisfaction) is an important clinical outcome measurement and a surrogate of anesthetic/surgical care quality. Objectives To compare the efficacy of a transversus abdominis plane (TAP) block with dexamethasone sodium phosphate and preperitoneal instillation of local anesthetic (PILA) with dexamethasone vs control on postoperative quality of recovery following a bilateral total extraperitoneal inguinal hernia repair (TEP-IHR) (>24 hours). Secondary objectives included efficacy of this technique on postoperative opioid use, nausea and vomiting, and pain scores. Design, Setting, and Participants Conducted from November 2013 to August 2015, this randomized, prospective, single-blinded study compared 2 groups (a TAP block and PILA) with a standard anesthetic technique with no regional technique (control) following bilateral TEP-IHR. This study at the Veterans Affairs Medical Center (Indianapolis, Indiana) included patients ages 18 to 80 years with an American Society of Anesthesiologists physical status of 1 to 3 scheduled for an outpatient bilateral TEP-IHR. Nurses assigning pain scores and administrating opioids for pain and staff anesthesiologists administering the Quality of Recovery–40 (QoR-40) questionnaire were blinded. Interventions Patients randomized to receive a TAP block with local anesthetics and dexamethasone, PILA with dexamethasone, or no regional technique (3 groups). Main Outcomes and Measures Patient’s response to the QoR-40 questionnaire following a TEP-IHR surgery. Results The mean (SD) ages in the TAP block (n = 19), PILA (n = 24), and control (n = 23) groups were 58.2 (9.4) years, 62.5 (8.1) years, and 62.9 (7.8) years, respectively. The global QoR-40 scores on postoperative day 1 for the TAP block group (median [interquartile range (IQR)], 178 [173-188]) were comparable with the control group (median [IQR], 174 [150-181]), while the PILA group had better global QoR-40 scores (median [IQR], 184 [175.5-190.75]) (P = .002). The effects of the TAP block and PILA on pain in the postoperative care unit (PACU) (median [IQR], 1 [0-5] and 3.5 [0-6.8], respectively), pain after discharge (median [IQR], 3 [2-5] and 3 [1-5.5], respectively), opiate use after discharge (median [IQR], 6.7 [5-10] and 6.7 [3.3-10], respectively), and incidence of nausea and vomiting in the PACU (4 of 19 [21.1%] and 6 of 24 [25%], respectively) were not significantly different from the control group (median [IQR], 4 [3-6] for pain scores in the PACU; 4 [3-7] for pain scores after discharge; 6.7 [3.3-10] for opioid use after discharge; and 6 of 23 [26.1%] for incidence of nausea/vomiting in the PACU). While there was a significant reduction of opioid use in the PACU in the TAP block group (median [IQR], 0 [0-1.3]) when compared with the control group (median [IQR], 4 [1.3-6.7]) (P = .001), this was not seen in the PILA group (median [IQR], 2 [0-6.4]). Conclusions and Relevance This study demonstrates a better quality of recovery in patients’ receiving PILA with dexamethasone compared with control for a TEP-IHR surgery

On the Disambiguation of Weighted Automata

We present a disambiguation algorithm for weighted automata. The algorithm admits two main stages: a pre-disambiguation stage followed by a transition removal stage. We give a detailed description of the algorithm and the proof of its correctness. The algorithm is not applicable to all weighted automata but we prove sufficient conditions for its applicability in the case of the tropical semiring by introducing the *weak twins property*. In particular, the algorithm can be used with all acyclic weighted automata, relevant to applications. While disambiguation can sometimes be achieved using determinization, our disambiguation algorithm in some cases can return a result that is exponentially smaller than any equivalent deterministic automaton. We also present some empirical evidence of the space benefits of disambiguation over determinization in speech recognition and machine translation applications

Rigid Origami Vertices: Conditions and Forcing Sets

We develop an intrinsic necessary and sufficient condition for single-vertex origami crease patterns to be able to fold rigidly. We classify such patterns in the case where the creases are pre-assigned to be mountains and valleys as well as in the unassigned case. We also illustrate the utility of this result by applying it to the new concept of minimal forcing sets for rigid origami models, which are the smallest collection of creases that, when folded, will force all the other creases to fold in a prescribed way

PENGARUH PENAMBAHAN LENSA NOZZLE DAN JUMLAH BLADE AIRFOIL TIPE NACA 4415 TERHADAP HASIL DAYA LISTRIK TURBIN ANGIN SUMBU HORISONTAL

Danur Lambang Pristiandaru. PENGARUH PENAMBAHAN LENSA NOZZLE TURBIN ANGIN DAN JUMLAH BLADE AIRFOIL TIPE NACA 4415 TERHADAP HASIL DAYA LISTRIK. Skripsi, Fakultas Keguruan dan Ilmu Pendidikan Universitas Sebelas Maret Surakarta. Januari 2016 Tujuan penelitian ini adalah: (1) Menyelidiki pengaruh jumlah blade pada turbin angin non-twisted blade tipe airfoil NACA 4415 terhadap daya listrik yang dihasilkan. (2) Menyelidiki pengaruh penambahan lensa nozzle pada turbin angin non-twisted blade tipe airfoil NACA 4415 terhadap daya listrik yang dihasilkan turbin angin. (3) Menyelidiki pengaruh bersama (interaksi) antara penambahan lensa nozzle dan jumlah blade terhadap daya listrik yang dihasilkan turbin angin. Penelitian ini menggunakan metode deskriptif kuantitatif. Sampel dalam penelitian ini adalah Turbin Angin Sumbu Horisontal (TASH) dengan desain blade airfoil NACA 4415 non-twisted. 3 desain lensa nozzle digunakan untuk mengetahui pengaruhnya terhadap peningkatan daya listrik TASH. Terdapat 3 variasi jumlah blade yaitu jumlah blade 2, jumlah blade 3, dan jumlah blade 4. Variasi kecepatan angin yang digunakan dalam penelitian ini adalah 2,5 m/s, 3,5 m/s, dan 4,5 m/s. Data diperoleh dengan melakukan pengujian TASH menggunakan angin rekayasa, daya listrik yang dihasilkan dibaca dan direkam oleh data logger. Data yang diperoleh dari hasil penelitian dimasukkan ke dalam tabel dan ditampilkan dalam bentuk grafik, kemudian dianalisis. Berdasarkan hasil penelitian dapat disimpulkan bahwa: (1) Adanya pengaruh variasi jumlah blade terhadap daya listrik turbin angin. TASH 3 blade menghasilkan daya listrik yang paling besar yaitu 0,7222 W pada kecepatan angin 4,5 m/s. (2) Adanya pengaruh penambahan lensa nozzle terhadap turbin angin. Lensa nozzle mampu meningkatkan hasil daya listrik turbin angin semua jenis variasi jumlah blade dibandingkan turbin angin tanpa lensa nozzle. (3) Ada pengaruh bersama yang signifikan antara variasi jumlah blade dan variasi jenis lensa terhadap daya listrik turbin angin. TASH 3 blade dengan lensa C pada kecepatan angin 4,5 m/s memiliki daya listrik tertinggi yaitu sebesar 0,82041 W. Daya listrik tersebut meningkat 13,60% dibanding TASH 3 blade tanpa penambahan lensa, yaitu 0,7222 W. Kata kunci: Turbin Angin, Lensa Nozzle, Daya Listrik, Data Logge

Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center

Importance There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. Objective To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Design, Setting, and Participants Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. Exposures The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Main Outcomes and Measures Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Results Following rapid process improvement workshop project rollouts, mean (SD) patient wait times for elective general surgical procedures decreased from 33.4 (8.3) days in FY 2012 to 26.0 (9.5) days in FY 2013 (P = .02). In FY 2014, mean (SD) wait times were half the value of the previous FY at 12.0 (2.1) days (P = .07). This was a 3-fold decrease from wait times in FY 2012 (P = .02). Operative volume increased from 931 patients in FY 2012 to 1090 in FY 2013 and 1072 in FY 2014. Combined clinic, telehealth, and e-consultation encounters increased from 3131 in FY 2012 to 3460 in FY 2013 and 3517 in FY 2014, while the number of no-shows decreased from 366 in FY 2012 to 227 in FY 2014 (P = .02). Conclusions and Relevance Improvement in the overall surgical patient experience can stem from multidisciplinary collaboration among systems redesign personnel, clinicians, and surgical staff to reduce systemic inefficiencies. Monitoring and follow-up of system efficiency measures and the employment of lean practices and process improvements can have positive short- and long-term effects on wait times, clinical throughput, and patient care and satisfaction

Planar and Poly-Arc Lombardi Drawings

In Lombardi drawings of graphs, edges are represented as circular arcs, and the edges incident on vertices have perfect angular resolution. However, not every graph has a Lombardi drawing, and not every planar graph has a planar Lombardi drawing. We introduce k-Lombardi drawings, in which each edge may be drawn with k circular arcs, noting that every graph has a smooth 2-Lombardi drawing. We show that every planar graph has a smooth planar 3-Lombardi drawing and further investigate topics connecting planarity and Lombardi drawings.Comment: Expanded version of paper appearing in the 19th International Symposium on Graph Drawing (GD 2011). 16 pages, 8 figure

Achieving Good Angular Resolution in 3D Arc Diagrams

We study a three-dimensional analogue to the well-known graph visualization approach known as arc diagrams. We provide several algorithms that achieve good angular resolution for 3D arc diagrams, even for cases when the arcs must project to a given 2D straight-line drawing of the input graph. Our methods make use of various graph coloring algorithms, including an algorithm for a new coloring problem, which we call localized edge coloring.Comment: 12 pages, 5 figures; to appear at the 21st International Symposium on Graph Drawing (GD 2013