Gabapentin for pain management after osmotic dilator insertion and prior to dilation and evacuation: A randomized controlled trial.

ObjectiveTo evaluate if gabapentin 600 mg reduces pain after osmotic dilator placement the day before a dilation and evacuation (D&E) procedure.Study designWe conducted a double-blind, placebo-controlled, randomized (stratified by vaginal parity) trial among women undergoing osmotic dilator placement before D&E at 15-23 5/7 weeks gestation. Subjects received gabapentin 600 mg or placebo 30 min before dilator placement, with re-dosing 8 h later. We assessed pain after dilator placement using a numeric rating scale (NRS; scale 0-10) at 5 min, 2, 4, and 8 h, and at presentation for D&E. The primary outcome was median NRS pain score change from baseline to 8 h after dilator placement. Secondary outcomes included gabapentin-related side effects and analgesic use.ResultsOf 121 randomized women, we excluded three subjects (allergic reaction [placebo], randomization error, no NRS data), leaving 60 gabapentin and 58 placebo subjects. Of 110 (93%) women who provided 8-hour data, median pain score changes from baseline did not differ between gabapentin and placebo groups overall (2 vs. 2.5, p = 0.52), in vaginally nulliparous women (2 vs. 4, p = 0.10) or in parous women (2 vs. 1.5, p = 0.37). We found no statistically significant differences in median pain score change from baseline to any timepoint overall or when stratified by parity. Beginning at 2 h after dilator placement, more gabapentin than placebo users experienced dizziness (29/53[55%] vs. 11/53[21%], p = 0.001) and tiredness (34/54[63%] vs. 17/54[31%], p = 0.002). The proportion of women using narcotics did not differ between gabapentin (35/60[58%]) or placebo (40/58[69%]) users (p = 0.26).ConclusionsGabapentin does not reduce pain with overnight osmotic dilator placement prior to D&E and causes drug-related side effects.Implications statementWomen experience pain, mostly mild to moderate, with overnight cervical dilator placement at 15-23 5/7 weeks gestation. About 2/3 of women will use a limited quantity of narcotics if provided. Gabapentin does not decrease the pain with or following dilator placement and does not decrease narcotic use

Instant Messenger Friends? Social Relationship Behavior Differences Between Two Countries

Canadian and U.S. respondents’ social behavior resulting from communication tools is examined.  Results suggest that Canadians are less likely to use social communication tools to develop new relationships

Referral Center Experience With Nonpalpable Contraceptive Implant Removals.

ObjectiveTo describe our experience with office removal of nonpalpable contraceptive implants at our referral center.MethodsWe performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp. We abstracted information on demographics, implant location, and outcomes.ResultsOf 61 referrals, 55 patients attended their scheduled appointments. Seven patients had palpable implants; six elected removal. The other 48 patients had ultrasound localization, which identified 47 (98%) of the implants; the remaining patient had successful localization with computed tomography imaging. Nonpalpable implants were suprafascial (n=22), subfascial (n=25) and intrafascial (n=1); four of these patients opted to delay removal. Of 50 attempted office removals, all palpable (n=6), all nonpalpable suprafascial (n=21 [100%, 95% CI 83-100%]), and 19 out of 23 (83%, 95% CI 67-98%) subfascial implants were successful. Three of the four patients with failed subfascial implant office removal had successful operating room removal with a collaborative orthopedic surgeon; the other patient sought removal elsewhere. Transient postprocedure neuropathic complaints were noted in 7 out of 23 (30%, 95% CI 12-49%) subfascial and 1 out of 21 (5%, 95% CI 0-13%) suprafascial removals (P=.048). Nonpalpable implants were more likely to be subfascial in nonobese patients (24/34, 71%) as compared with obese (1/13, 8%) patients (P<.001). Seven (28%) of the 25 subfascially located implants had been inserted during a removal-reinsertion procedure through the same incision.ConclusionMost nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization. Some patients may experience transient postprocedure neuropathic pain. Nonpalpable implants in thinner women are more likely to be in a subfascial location

The functional role of producer diversity in ecosystems

Over the past several decades, a rapidly expanding field of research known as biodiversity and ecosystem functioning has begun to quantify how the world\u27s biological diversity can, as an independent variable, control ecological processes that are both essential for, and fundamental to, the functioning of ecosystems. Research in this area has often been justified on grounds that (1) loss of biological diversity ranks among the most pronounced changes to the global environment and that (2) reductions in diversity, and corresponding changes in species composition, could alter important services that ecosystems provide to humanity (e.g., food production, pest/disease control, water purification). Here we review over two decades of experiments that have examined how species richness of primary producers influences the suite of ecological processes that are controlled by plants and algae in terrestrial, marine, and freshwater ecosystems. Using formal meta-analyses, we assess the balance of evidence for eight fundamental questions and corresponding hypotheses about the functional role of producer diversity in ecosystems. These include questions about how primary producer diversity influences the efficiency of resource use and biomass production in ecosystems, how primary producer diversity influences the transfer and recycling of biomass to other trophic groups in a food web, and the number of species and spatial /temporal scales at which diversity effects are most apparent. After summarizing the balance of evidence and stating our own confidence in the conclusions, we outline several new questions that must now be addressed if this field is going to evolve into a predictive science that can help conserve and manage ecological processes in ecosystems

Ultra-High Energy Cosmic Rays Detected by Auger and AGASA:Corrections for Galactic Magnetic Field Deflections, Source Populations, and Arguments for Multiple-Components

The origin and composition of Ultra-High Energy Cosmic Ray Events (UHECRs) are under debate. Here we improve constraints on the source population(s) and compositions of UHECRs by accounting for UHECR deflections within existing Galactic magnetic field models (GMFs). We used Monte Carlo simulations for UHECRs detected by the Pierre Auger Observatory and AGASA in order to determine their outside-the-Galaxy arrival directions, and compared these with Galactic and extragalactic sources. The simulations, which used UHECR compositions from protons to Iron and seven models of the ordered GMF, include uncertainties in the GMF and a turbulent magnetic field. The correlation between UHECRs and nearby extended radiogalaxies (Nagar & Matulich 2008) remains valid, even strengthened, within several GMF models. Both the nearest radiogalaxy CenA, and the nearest radio-extended BL Lac, CGCG 413-019, are likely sources of multiple UHECRs. The correlation appears to be linked to the presence of the extended radio source rather than a tracer of an underlying population. It is possible, but unlikely, that all UHECRs originate in the nearby radiogalaxy CenA. For light UHECRs about a third of UHECRs can be "matched" to nearby galaxies with extended radio jets. The remaining UHECRs could also be explained as originating in extended radiogalaxies if one has at least one of: a large UHECR mean free path, a high cluster and/or intergalactic magnetic field, a heavy composition for two-thirds of the detected UHECRs. Several UHECRs have trajectories which pass close to Galactic magnetars and/or microquasars. If extended radiogalaxies are, or trace, UHECR sources, the most consistent models for the ordered GMF are the BS-S and BS-A models; the GMF models of Sun et al. 2008 are acceptable if a dipole component is added.Comment: to appear in A&

Ultra-High Energy Cosmic Rays Detected by the Pierre Auger Observatory: First Direct Evidence, and its Implications, that a Subset Originate in Nearby Radiogalaxies

(abridged) The Pierre Auger Collaboration has reported 27 Ultra-High Energy Cosmic Ray Events (UHECRs) with energies above 56 EeV and well determined arrival directions as of 2007 August 31. They find that the arrival directions are not isotropic, but instead appear correlated with the positions of nearby AGNs. Our aim was to determine the sources of these UHECRs by comparing their arrival directions with more comprehensive source catalogs. Four (eight) of the 27 UHECRs with energy >56EeV detected by the Pierre Auger Observatory have arrival directions within 1.5deg (3.5deg) of the extended (>180kpc) radio structures of nearby radiogalaxies or the single nearby BLLac with extended radio structure. Conversely the radio structures of three (six) of all ten nearest extended radiogalaxies are within 1.5deg (3.5deg) of a UHECR; three of the remaining four radiogalaxies are in directions with lower exposure times. This correlation between nearby extended radiogalaxies and a subset of UHECRs is significant at the 99.9% level. This is the first direct observational proof that radio galaxies are a significant source of UHECRs. For the remaining ~20 UHECRs, an isotropic distribution cannot be ruled out at high significance. The correlation found by the Auger Collaboration between the 27 UHECRs and AGNs in the Veron-Cetty & Veron catalog at D < 71Mpc has a much lower significance when one considers only the ~20 UHECRs not `matched' to nearby extended radiogalaxies. No correlation is seen between UHECRs and supernovae, supernova remnants, nearby galaxies, or nearby groups and clusters of galaxies. The primary difference between the UHECR detections at the Pierre Auger Observatory and previous experiments may thus be that the Southern Hemisphere is more privileged with respect to nearby extended radiogalaxies.Comment: 10 pages total. To appear in A&

Phase transitions for the Lifshitz black holes

We study possibility of phase transitions between Lifshitz black holes and other configurations by using free energies explicitly. A phase transition between Lifshitz soliton and Lifshitz black hole might not occur in three dimensions. We find that a phase transition between Lifshitz and BTZ black holes unlikely occurs because they have different asymptotes. Similarly, we point out that any phase transition between Lifshitz and black branes unlikely occurs in four dimensions since they have different asymptotes. This is consistent with a necessary condition for taking a phase transition in the gravitational system, which requires the same asymptote.Comment: 19 pages, 7 figures, a revised version to appear in EPJ

Absorption cross section in Lifshitz black hole

We derive the absorption cross section of a minimally coupled scalar in the Lifshitz black hole obtained from the new massive gravity. The absorption cross section reduces to the horizon area in the low energy and massless limit of s-wave mode propagation, indicating that the Lifshitz black hole also satisfies the universality of low energy absorption cross section for black holes.Comment: 13 pages, 1 figure, version to appear in EPJ

Asymptotically Lifshitz wormholes and black holes for Lovelock gravity in vacuum

Static asymptotically Lifshitz wormholes and black holes in vacuum are shown to exist for a class of Lovelock theories in d=2n+1>7 dimensions, selected by requiring that all but one of their n maximally symmetric vacua are AdS of radius l and degenerate. The wormhole geometry is regular everywhere and connects two Lifshitz spacetimes with a nontrivial geometry at the boundary. The dynamical exponent z is determined by the quotient of the curvature radii of the maximally symmetric vacua according to n(z^2-1)+1=(l/L)^2, where L corresponds to the curvature radius of the nondegenerate vacuum. Light signals are able to connect both asymptotic regions in finite time, and the gravitational field pulls towards a fixed surface located at some arbitrary proper distance to the neck. The asymptotically Lifshitz black hole possesses the same dynamical exponent and a fixed Hawking temperature given by T=z/(2^z pi l). Further analytic solutions, including pure Lifshitz spacetimes with a nontrivial geometry at the spacelike boundary, and wormholes that interpolate between asymptotically Lifshitz spacetimes with different dynamical exponents are also found.Comment: 19 pages, 1 figur