Virtual Reality after Surgery—A Method to Decrease Pain After Surgery in Pediatric Patients

Background: Virtual Reality (VR) is used as an effective tool for distraction and as an adjunct for pain management. This study was conducted to compare VR to standard iPad use after surgery and examine its effect on pain score and opioid consumption. Methods: This was a randomized controlled study, with stratification by surgery type, age group (7-12yo, 13-18yo) and gender. Pain and anxiety were assessed with validated scales (STAI, FACES, VAS, FLACC) and outcomes were compared between each group. Results: 50 of the 106 enrolled patients used the VR device. After adjusting for age, gender, and STAI, patients had a decreased FLACC score while using the VR device compared to the iPad group (odds ratio 2.95, P =.021). The younger patients were found to have lower FLACC scores while using the VR device (odds ratio 1.15, p=0.044); this finding was most significant when patients used the VR device for 20-30 minutes (odds ratio 1.67, P =.0003). Additionally, after adjusting for treatment group, gender, and STAI, the younger patients had higher odds of withdrawal or exclusion from the study (odds ratio 1.18, P =.021). No significant difference in opioid consumption between the groups was found. Discussion: Virtual reality was well tolerated and more effective in decreasing pain during the immediate postoperative period than iPad use. Despite a slightly higher withdrawal rate, younger patients benefited more from the intervention

Cost calculation and prediction in adult intensive care: A ground-up utilization study

Publisher's copy made available with the permission of the publisherThe ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 $AUS) were$6801 ($10311), with median costs of$2534, range $106 to$95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.J. L. Moran, A. R. Peisach, P. J. Solomon, J. Martinhttp://www.aaic.net.au/Article.asp?D=200403

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Damage in CFRP composites subjected to simulated lighting strikes - Assessment of thermal and mechanical responses

Damage is inflicted upon Carbon Fiber Reinforced Polymer (CFRP) composite laminates using simulated lightning strikes to investigate the resulting residual mechanical properties. Seven different CFRP laminate specimens were exposed to simulated lightning strikes using three different electric waveforms. The three waveforms imposed were the 10/350 μs waveform, which simulates the first return stroke during a direct strike according to IEC 61400–24 Ed1.0. The second was a unipolar long stroke component, and the third was a combination of the first return stroke and the long stroke. After exposure to lightning, coupon specimens were prepared for mechanical testing. The test specimens were subsequently subjected to compression and shear loading to determine the post-strike mechanical properties. The compression tests were conducted using uniaxial coupons in accordance with ASTM standard D6641. The shear tests were conducted using V-notch specimens utilizing an Iosipescu test rig in accordance with ASTM standard D5379. Digital Image Correlation was used to capture the strain fields on the surface of the specimens. The results of the material coupon tests are compared with test results from pristine CFRP coupon samples that were not exposed to any electrical current. The shear and compression strengths, compressive and shear stress-strain curves, compressive and shear moduli, and the maximum temperature on the CFRP specimens during lightning tests are presented and discussed. Key results include that the largest reduction of strength occurred in the specimens that were subjected to the largest current and specific energy. The specific energy correlated more closely to the observed reduction of residual strength than the charge, and the damaged specimens displayed a higher degree of nonlinear stress-strain behavior than the pristine specimens

Hsp90-binding immunophilins link p53 to dynein during p53 transport to the nucleus

The tumor suppressor protein p53 is known to be transported to the nucleus along microtubular tracks by cytoplasmic dynein. However, the connection between p53 and the dynein motor protein complex has not been established. Here, we show that hsp90·binding immunophilins link p53·hsp90 complexes to dynein and that prevention of that linkage in vivo inhibits the nuclear movement of p53. First, we show that p53·hsp90 heterocomplexes from DLD-1 human colon cancer cells contain an immunophilin (FKBP52, CyP-40, or PP5) as well as dynein. p53·hsp90·immunophilin·dynein complexes can be formed by incubating immunopurified p53 with rabbit reticulocyte lysate, and we show by peptide competition that the immunophilins link via their tetratricopeptide repeat domains to p53-bound hsp90 and by means of their PPIase domains to the dynein complex. The linkage of immunophilins to the dynein motor is indirect by means of the dynamitin component of the dynein-associated dynactin complex, and we show that purified FKBP52 binds directly by means of its PPIase domain to purified dynamitin. By using a temperature-sensitive mutant of p53 where cytoplasmic-nuclear movement occurs by shift to permissive temperature, we show that p53 movement is impeded when p53 binding to hsp90 is inhibited by the hsp90 inhibitor radicicol. Also, nuclear movement of p53 is inhibited when immunophilin binding to dynein is competed for by expression of a PPIase domain fragment in the same manner as when dynein linkage to cargo is dissociated by expression of dynamitin. This is the first demonstration of the linkage between an hsp90-chaperoned transcription factor and the system for its retrograde movement to the nucleus both in vitro and in vivo

Lightning protection of CFRP wind turbine blades - What is the dominant cause of failure: Specific energy or charge?

This paper investigated which component of a lightning strike is responsible for the majority of damage in Carbon Fiber Reinforced Plastic (CFRP) by investigating the strength loss induced by the exposure to two different electric current waveforms. The two waveforms used were the 10/350μs waveform simulating the first return stroke during a direct strike according to IEC 61400-24 Ed1.0 and the second was a unipolar long stroke component. CFRP strip specimens were manufactured and subjected to the two waveforms of electric current to simulate a lightning strike event. After exposure, specimens were extracted from the CFRP strips, and then loaded in compression and shear to determine the residual strength remaining. The compression tests were conducted on uniaxial coupons and loaded in accordance to ASTM standard D6641. Shear tests were conducted on V-notch specimens and loaded in an Iosipescu test rig in accordance to ASTM standard D5379. The results of the tests were compared to CFRP coupons, which were not exposed to any electrical current. A comparison between undamaged specimens and damaged specimens was made to determine which has more effect on the strength degradation; electric charge from the long stroke component or specific energy from the first return stroke. The results show that impulse current has more impact on strength degradation than a unipolar long stroke current

Heat response of unipolar lightning impulse and DC current component conducted through CFRP samples used for wind turbine sparcaps

Lightning protection of wind turbine blades has reached much attention due to the increased number of blade manufacturers now featuring blade designs that include conductive Carbon Fiber Reinforced Polymers (CFRP) composites for structural components. CFRP materials are stiff and lightweight, but exhibit material properties different from other conductive materials like metals, making them more susceptible to lightning damage. The weaknesses observed is governed by the limited electrical and thermal conductivity, transverse to the fibers, the anisotropic material properties, and the integration of the CFRP into the overall WT blade or aerospace structure. This study investigates in detail the heat response on CFRP material exposed to two different components of a lightning strike; the unipolar impulse current and the direct current (DC). The first waveform examined is a unipolar 10/350µs waveform simulating the first return stroke during a direct strike according to IEC 61400-24 Ed1.0 , the second being a unipolar long stroke component also defined by the IEC standards. Both current components are tested using the conducted current test method provided in Annex D3.4 of IEC 61400-24 Ed1.01.CFRP strips made with vacuum assisted liquid resin infusion were exposed to conducting currents as defined above using the two different waveforms. A PYROVIEW 640L IR camera was used to monitor the heat response of each sample. The data from the center of the sample was used to collect the heat response and the results can be seen in Figure 1 and Figure 2. This data helps determine thermal response models to help determine damage from thermal degradation due to electric current