A supraomohyoidal plexus block designed to avoid complications

Interscalene blocks of the brachial plexus are used for surgery of the shoulder and are frequently associated with complications such as temporary phrenic block, Horner syndrome or hematoma. To minimize the risk of these complications, we developed an approach that avoids medially directed needle advancement and favors spread to lateral regions only: the supraomohyoidal block. We tested this procedure in 11 cadavers fixed by Thiel's method. The insertion site is at the lateral margin of the sternocleidomastoid muscle at the level of the cricoid cartilage. The needle is inserted in the axis of the plexus with an angle of approximately 35° to the skin, and advanced in lateral and caudal direction. Distribution of solution was determined in ten cadavers after bilateral injection of colored solution (20 and 30ml) and followed by dissection. In an eleventh cadaver, computerized tomography and 3D reconstruction after radio contrast injection was performed. In additional five cadavers we performed Winnie's technique with bilateral injection (20 and 30ml).Concerning the supraomohyoidal block the injection mass reached the infraclavicular region surrounded all trunks of the brachial plexus in the supraclavicular region and the suprascapular nerve in all cases. The solution did not spread medially beyond the lateral margin of the anterior scalene muscle into the scalenovertebral triangle. Therefore, phrenic nerve, stellate ganglion, laryngeal nerve nor the vertebral artery were exposed to the injected solution. Distribution was comparable with the use of 20 and 30ml of solution. Injections on five cadavers performing the interscalene block of Winnie resulted in an extended spread medially to the anterior scalene muscle.We conclude that our method may be a preferred approach due to its safety, because no structures out of interest were reached. Solution of 20ml is suggested to be enough for a successful bloc

Bayesian Peer Calibration with Application to Alcohol Use

Peers are often able to provide important additional information to supplement self-reported behavioral measures. The study motivating this work collected data on alcohol in a social network formed by college students living in a freshman dormitory. By using two imperfect sources of information (self-reported and peer-reported alcohol consumption), rather than solely self-reports or peer-reports, we are able to gain insight into alcohol consumption on both the population and the individual level, as well as information on the discrepancy of individual peer-reports. We develop a novel Bayesian comparative calibration model for continuous, count and binary outcomes that uses covariate information to characterize the joint distribution of both self and peer-reports on the network for estimating peer-reporting discrepancies in network surveys, and apply this to the data for fully Bayesian inference. We use this model to understand the effects of covariates on both drinking behavior and peer-reporting discrepancies

Reduced Bias for Respondent Driven Sampling: Accounting for Non-Uniform Edge Sampling Probabilities in People Who Inject Drugs in Mauritius

People who inject drugs are an important population to study in order to reduce transmission of blood-borne illnesses including HIV and Hepatitis. In this paper we estimate the HIV and Hepatitis C prevalence among people who inject drugs, as well as the proportion of people who inject drugs who are female in Mauritius. Respondent driven sampling (RDS), a widely adopted link-tracing sampling design used to collect samples from hard-to-reach human populations, was used to collect this sample. The random walk approximation underlying many common RDS estimators assumes that each social relation (edge) in the underlying social network has an equal probability of being traced in the collection of the sample. This assumption does not hold in practice. We show that certain RDS estimators are sensitive to the violation of this assumption. In order to address this limitation in current methodology, and the impact it may have on prevalence estimates, we present a new method for improving RDS prevalence estimators using estimated edge inclusion probabilities, and apply this to data from Mauritius

Fixed Choice Design and Augmented Fixed Choice Design for Network Data with Missing Observations

The statistical analysis of social networks is increasingly used to understand social processes and patterns. The association between social relationships and individual behaviors is of particular interest to sociologists, psychologists, and public health researchers. Several recent network studies make use of the fixed choice design (FCD), which induces missing edges in the network data. Because of the complex dependence structure inherent in networks, missing data can pose very difficult problems for valid statistical inference. In this article, we introduce novel methods for accounting for the FCD censoring and introduce a new survey design, which we call the augmented fixed choice design (AFCD). The AFCD adds considerable information to analyses without unduly burdening the survey respondent, resulting in improvements over the FCD, and other existing estimators. We demonstrate this new method through simulation studies and an analysis of alcohol use in a network of undergraduate students living in a residence hall

Revisit of the Interaction between Holographic Dark Energy and Dark Matter

In this paper we investigate the possible direct, non-gravitational interaction between holographic dark energy (HDE) and dark matter. Firstly, we start with two simple models with the interaction terms $Q \propto \rho_{dm}$ and $Q \propto \rho_{de}$, and then we move on to the general form $Q \propto \rho_m^\alpha\rho_{de}^\beta$. The cosmological constraints of the models are obtained from the joint analysis of the present Union2.1+BAO+CMB+$H_0$ data. We find that the data slightly favor an energy flow from dark matter to dark energy, although the original HDE model still lies in the 95.4% confidence level (CL) region. For all models we find $c<1$ at the 95.4% CL. We show that compared with the cosmic expansion, the effect of interaction on the evolution of $\rho_{dm}$ and $\rho_{de}$ is smaller, and the relative increment (decrement) amount of the energy in the dark matter component is constrained to be less than 9% (15%) at the 95.4% CL. By introducing the interaction, we find that even when $c<1$ the big rip still can be avoided due to the existence of a de Sitter solution at $z\rightarrow-1$. We show that this solution can not be accomplished in the two simple models, while for the general model such a solution can be achieved with a large $\beta$, and the big rip may be avoided at the 95.4% CL.Comment: 26 pages, 9 figures, version accepted for publication in JCA

Lentiviral gene transfer into the dorsal root ganglion of adult rats

<p>Abstract</p> <p>Background</p> <p>Lentivector-mediated gene delivery into the dorsal root ganglion (DRG) is a promising method for exploring pain pathophysiology and for genetic treatment of chronic neuropathic pain. In this study, a series of modified lentivector particles with different cellular promoters, envelope glycoproteins, and viral accessory proteins were generated to evaluate the requirements for efficient transduction into neuronal cells <it>in vitro </it>and adult rat DRG <it>in vivo</it>.</p> <p>Results</p> <p><it>In vitro</it>, lentivectors expressing enhanced green fluorescent protein (EGFP) under control of the human elongation factor 1α (EF1α) promoter and pseudotyped with the conventional vesicular stomatitis virus G protein (VSV-G) envelope exhibited the best performance in the transfer of EGFP into an immortalized DRG sensory neuron cell line at low multiplicities of infection (MOIs), and into primary cultured DRG neurons at higher MOIs. <it>In vivo</it>, injection of either first or second-generation EF1α-EGFP lentivectors directly into adult rat DRGs led to transduction rates of 19 ± 9% and 20 ± 8% EGFP-positive DRG neurons, respectively, detected at 4 weeks post injection. Transduced cells included a full range of neuronal phenotypes, including myelinated neurons as well as both non-peptidergic and peptidergic nociceptive unmyelinated neurons.</p> <p>Conclusion</p> <p>VSV-G pseudotyped lentivectors containing the human elongation factor 1α (EF1α)-EGFP expression cassette demonstrated relatively efficient transduction to sensory neurons following direct injection into the DRG. These results clearly show the potential of lentivectors as a viable system for delivering target genes into DRGs to explore basic mechanisms of neuropathic pain, with the potential for future clinical use in treating chronic pain.</p

Past and Future Land Use Impacts of Canadian Oil Sands and Greenhouse Gas Emissions

The Canadian oil sands underlie 142,000 km2 of the boreal forest in northeastern Alberta. Oil sands production greenhouse gas (GHG) emissions increased from 15 million tonnes (Mt) to 55 Mt between 1990 and 2011. Their production represents the fastest-growing source of GHG emissions in Canada. A large body of studies show that oil sands industries have large environmental impacts, including effects on climate, land, water, and air quality but GHG emissions from oil sands land use disturbance and future land use impacts have yet to be examined in detail and the associated literature is scarce and incomplete. Our paper examines the historical and potential land use change and GHG emissions associated with oil sands development in Canada. Disturbance occurred between 1985 and 2009 from oil sands development were identified using remote sensing technique and mapped onto spatially explicit soil, biomass and peatlands carbon maps. We found that land use and GHG disturbance of oil sands production, especially in-situ technology that will be the dominant technology of choice for future oil sands development, are greater than previously reported. We estimate additional 500 km2 and 2,400 km2 of boreal forest including carbon-rich peatlands would be disturbed from surface mining and in-situ production, respectively, between 2012 and 2030; releasing additional 107–182 million tonnes of GHG from land use alone. Future efforts to monitor land use impacts of in-situ production are needed to reduce landscape impacts and associated GHG emissions. In addition, land reclamation after oil sands projects needs to be enforced for broad ecological benefits together with GHG benefits

Automated electronic medical record sepsis detection in the emergency department

Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system.Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and laboratory test information on all ED patients, triggering a “sepsis alert” for those with ≥2 SIRS (systemic inflammatory response syndrome) criteria (fever, tachycardia, tachypnea, leukocytosis) plus ≥1 major organ dysfunction (SBP ≤ 90 mm Hg, lactic acid ≥2.0 mg/dL). We confirmed the presence of sepsis through manual review of physician, nursing, and laboratory records. We also reviewed a random selection of ED cases that did not trigger a sepsis alert. We evaluated the diagnostic accuracy of the sepsis identification tool.Results. From January 1 through March 31, 2012, there were 795 automated sepsis alerts. We randomly selected 300 cases without a sepsis alert from the same period. The true prevalence of sepsis was 355/795 (44.7%) among alerts and 0/300 (0%) among non-alerts. The positive predictive value of the sepsis alert was 44.7% (95% CI [41.2–48.2%]). Pneumonia and respiratory infections (38%) and urinary tract infection (32.7%) were the most common infections among the 355 patients with true sepsis (true positives). Among false-positive sepsis alerts, the most common medical conditions were gastrointestinal (26.1%), traumatic (25.7%), and cardiovascular (20.0%) conditions. Rates of hospital admission were: true-positive sepsis alert 91.0%, false-positive alert 83.0%, no sepsis alert 5.7%.Conclusions. This ED EMR-based automated sepsis identification system was able to detect cases with sepsis. Automated EMR-based detection may provide a viable strategy for identifying sepsis in the ED

Holographic dark energy in a universe with spatial curvature and massive neutrinos: a full Markov Chain Monte Carlo exploration

In this paper, we report the results of constraining the holographic dark energy model with spatial curvature and massive neutrinos, based on a Markov Chain Monte Carlo global fit technique. The cosmic observational data include the full WMAP 7-yr temperature and polarization data, the type Ia supernova data from Union2.1 sample, the baryon acoustic oscillation data from SDSS DR7 and WiggleZ Dark Energy Survey, and the latest measurements of $H_0$ from HST. To deal with the perturbations of dark energy, we adopt the parameterized post-Friedmann method. We find that, for the simplest holographic dark energy model without spatial curvature and massive neutrinos, the phenomenological parameter $c<1$ at more than $4\sigma$ confidence level. The inclusion of spatial curvature enlarges the error bars and leads to $c<1$ only in about $2.5\sigma$ range; in contrast, the inclusion of massive neutrinos does not have significant influence on $c$. We also find that, for the holographic dark energy model with spatial curvature but without massive neutrinos, the $3\sigma$ error bars of the current fractional curvature density $\Omega_{k0}$ are still in order of $10^{-2}$; for the model with massive neutrinos but without spatial curvature, the $2\sigma$ upper bound of the total mass of neutrinos is $\sum m_{\nu} < 0.48$ eV. Moreover, there exists clear degeneracy between spatial curvature and massive neutrinos in the holographic dark energy model, which enlarges the upper bound of $\sum m_{\nu}$ by more than 2 times. In addition, we demonstrate that, making use of the full WMAP data can give better constraints on the holographic dark energy model, compared with the case using the WMAP ``distance priors''.Comment: 21 pages, 10 figures; major revision; new figures and discussions added; accepted by JCA