COMPARING NERVE BLOCK PAIN PUMPS TO STANDARD OF CARE IN PATIENTS FOLLOWING CARDIOTHORACIC SURGERY

INTRODUCTION: Post-operative pain management following cardiothoracic surgery (CTS) can be challenging. Although opioids are commonly prescribed, multimodal strategies are used to decrease opioid consumption. One strategy includes the use of local anesthetics via peripheral nerve block pain pumps (PNBPP). However, literature in CTS patients is limited and conflicting. This study evaluated the efficacy and safety of PNBPP in patients following CTS. METHODS: This was a quasi-experimental study that included adult patients admitted to the cardiac intensive care unit following CTS. The intervention group included those who received PNBPP and they were compared to a group that received standard of care (SOC). The primary endpoint was the total oral morphine milligram equivalents (MMEs) used in the four days following surgery. Secondary endpoints included adverse events, incidence of post-operative ileus, time to first bowel movement, pain scores, length of stay and cost of intervention. Statistical analysis was performed with Chi-square, Fisher\u27s exact, Mann-Whitney U and t-tests where appropriate (IBM SPSS Statistics Software version 28.0.1.1). A sample size of 126 was calculated to detect a 50% reduction in opioid consumption with an alpha of 0.05 and power of 80%. RESULTS: Baseline characteristics were similar between groups with a median age of 60 and 63 in the PNBPP and SOC groups, respectively. The majority of patients were male and had a coronary artery bypass graft performed. Median oral MMEs was 375 (IQR: 268.5, 457.5) in the SOC group compared to 304.5 (IQR: 240, 416) in the PNBPP group (p-value 0.189). When comparing the SOC and PNBPP groups, incidence of post-operative ileus was 2 (3.2%) and 12 (19%) (p-value 0.005) with median time in hours to first bowel movement of 68.38 (IQR: 50.31, 85.50) and 66.11 (IQR: 50.28, 76.13) (p-value 0.336). There was no significant difference between groups in pain scores or length of stay. Median cost (USD) of PNBPP therapy was $125 in those that received an electronic pump and$3,138 in those that received an elastomeric pump. CONCLUSIONS: Addition of PNBPP post-CTS did not significantly reduce opioid consumption compared to SOC. Larger studies are needed to better define the role of PNBPP in post-operative pain management following CTS

Reordering buffer management with advice

In the reordering buffer management problem, a sequence of colored items arrives at a service station to be processed. Each color change between two consecutively processed items generates some cost. A reordering buffer of capacity k items can be used to preprocess the input sequence in order to decrease the number of color changes. The goal is to find a scheduling strategy that, using the reordering buffer, minimizes the number of color changes in the given sequence of items. We consider the problem in the setting of online computation with advice. In this model, the color of an item becomes known only at the time when the item enters the reordering buffer. Additionally, together with each item entering the buffer, we get a fixed number of advice bits, which can be seen as information about the future or as information about an optimal solution (or an approximation thereof) for the whole input sequence. We show that for any ε>0 there is a (1+ε)-competitive algorithm for the problem which uses only a constant (depending on ε) number of advice bits per input item. This also immediately implies a (1+ε)-approximation algorithm which has 2O(nlog1/ε) running time (this should be compared to the trivial optimal algorithm which has a running time of kO(n)). We complement the above result by presenting a lower bound of Ω(logk) bits of advice per request for any 1-competitive algorithm

Revisiting our Evolutionary Path: The Search for Holistic Education in a Fragmented World

When the World Academy of Art & Science (WAAS) was founded, it sought to address the gap between science and society, or rather the apparent unwillingness or inability of scientists to address their responsibilities as important members of society. This problem is related to the growing disparity between tool making and symbol making, those ancient skills that brought humans to the highest stage in the evolutionary process (at least until now?). Symbols—language, mathematics, graphics and other pictorial and linguistic representations, as well as clothing, hairstyles, etc.—when used to establish social rank, may serve to give legitimacy to the current social order or may serve to criticize and change it. Reincorporating science into society would require that scientists, as well as every member of society, recognize this. This would require an educational system that would give equal emphasis to tool making and symbol making, and this would help students to understand how society is a product of both of these processes

Unorthodox Thoughts on the Economic Crisis and the Dictum of Protagoras

The current economic crisis can be explained but we must remember that the crisis is the product of human behavior, both theoretical and practical, and not the product of some force of nature or mathematical law. An economic system is based upon production and consumption. A crisis arises whenever there is an imbalance between these two activities. Until the industrial revolution there was not sufficient production to meet the consumption needs of the world’s population. After years of science and technology there is now a surplus of goods and services in advanced countries related to the ability of consumers to purchase them. Therefore, a huge effort has been made since the end of the 19th century to increase consumption, not by distributing wealth more evenly but by extending credit through various means, while also “teaching” people that unless they consume more they are “inadequate” human beings. The uneven distribution of wealth has meant that there are fewer opportunities for investment in production for the excessive wealth of the few, so that it is then directed to speculation of every kind. There is disagreement among economists about whether and how democratically elected governments should intervene to redress this imbalance between production and consumption. Thus, capital sits idly in banks while a lack of income plagues a growing percentage of the population, leading to a social crisis and loss of belief in the ability of the economic system to work properly. All this because we have forgotten Protagoras’ dictum that the human being should be the measure of all things

Evaluation of online strategies for reordering buffers

Abstract. A sequence of objects which are characterized by their color has to be processed. Their processing order influences how efficiently they can be processed: Each color change between two consecutive objects produces costs. A reordering buffer which is a random access buffer with storage capacity for k objects can be used to rearrange this sequence online in such a way that the total costs are reduced. This concept is useful for many applications in computer science and economics. The strategy with the best known competitive ratio is MAP. An upper bound of O(log k) on the competitive ratio of MAP is known and a non-constant lower bound on the competitive ratio is not known [2]. Based on theoretical considerations and experimental evaluations, we give strong evidence that the previously used proof techniques are not suitable to show an o ( √ log k) upper bound on the competitive ratio of MAP. However, we also give some evidence that in fact MAP achieves a competitive ratio of O(1). Further, we evaluate the performance of several strategies on random input sequences experimentally. MAP and its variants RC and RR clearly outperform the other strategies FIFO, LRU, and MCF. In particular, MAP, RC, and RR are the only known strategies whose competitive ratios do not depend on the buffer size. Furthermore, MAP achieves the smallest constant competitive ratio.