Noninvasive Sphenopalatine Ganglion Block for Acute Headache in the Emergency Department: A Randomized Placebo-Controlled Trial

Study objective We seek to test the efficacy of noninvasive sphenopalatine ganglion block for the treatment of acute anterior headache in the emergency department (ED) using a novel noninvasive delivery device. Methods We conducted a randomized, double-blind, placebo-controlled trial evaluating bupivacaine anesthesia of the sphenopalatine ganglion for acute anterior or global-based headache. This study was completed in 2 large academic EDs. Bupivacaine or normal saline solution was delivered intranasally (0.3 mL per side) with the Tx360 device. Pain and nausea were measured at 0, 5, and 15 minutes by a 100-mm visual analog scale. The primary endpoint was a 50% reduction in pain at 15 minutes. Telephone follow-up assessed 24-hour pain and nausea through a 0- to 10-point verbal scale and adverse effects. Results The median reported baseline pain in the bupivacaine group was 80 mm (IQR 66 mm - 93 mm) and 78.5 mm (IQR 64 mm to 91.75 mm) in the normal saline solution group. A 50% reduction in pain was achieved in 48.8% of the bupivacaine group (20/41 patients) versus 41.3% in the normal saline solution group (19/46 patients), for an absolute risk difference of 7.5% (95% confidence interval [CI] –13% to 27.1%). As a secondary outcome, at 24 hours, more patients in the bupivacaine group were headache free (24.7% difference; 95% CI 2.6% to 43.6%) and more were nausea free (16.9% difference; 95% CI 0.8% to 32.5%). Conclusion For patients with acute anterior headache, sphenopalatine ganglion block with the Tx360 device with bupivacaine did not result in a significant increase in the proportion of patients achieving a greater than or equal to 50% reduction in headache severity at 15 minutes compared with saline solution applied in the same manner

Solving Disjunctive Temporal Networks with Uncertainty under Restricted Time-Based Controllability using Tree Search and Graph Neural Networks

Planning under uncertainty is an area of interest in artificial intelligence. We present a novel approach based on tree search and graph machine learning for the scheduling problem known as Disjunctive Temporal Networks with Uncertainty (DTNU). Dynamic Controllability (DC) of DTNUs seeks a reactive scheduling strategy to satisfy temporal constraints in response to uncontrollable action durations. We introduce new semantics for reactive scheduling: Time-based Dynamic Controllability (TDC) and a restricted subset of TDC, R-TDC. We design a tree search algorithm to determine whether or not a DTNU is R-TDC. Moreover, we leverage a graph neural network as a heuristic for tree search guidance. Finally, we conduct experiments on a known benchmark on which we show R-TDC to retain significant completeness with regard to DC, while being faster to prove. This results in the tree search processing fifty percent more DTNU problems in R-TDC than the state-of-the-art DC solver does in DC with the same time budget. We also observe that graph neural network search guidance leads to substantial performance gains on benchmarks of more complex DTNUs, with up to eleven times more problems solved than the baseline tree search.Comment: Thirty-Sixth AAAI Conference on Artificial Intelligence. This version includes the technical appendix. arXiv admin note: substantial text overlap with arXiv:2108.0106

Oncomodulin, an EF-hand Ca2+ buffer, is critical for maintaining cochlear function in mice

UNLABELLED: Oncomodulin (Ocm), a member of the parvalbumin family of calcium binding proteins, is expressed predominantly by cochlear outer hair cells in subcellular regions associated with either mechanoelectric transduction or electromotility. Targeted deletion of Ocm caused progressive cochlear dysfunction. Although sound-evoked responses are normal at 1 month, by 4 months, mutants show only minimal distortion product otoacoustic emissions and 70-80 dB threshold shifts in auditory brainstem responses. Thus, Ocm is not critical for cochlear development but does play an essential role for cochlear function in the adult mouse. SIGNIFICANCE STATEMENT: Numerous proteins act as buffers, sensors, or pumps to control calcium levels in cochlear hair cells. In the inner ear, EF-hand calcium buffers may play a significant role in hair cell function but have been very difficult to study. Unlike other reports of genetic disruption of EF-hand calcium buffers, deletion of oncomodulin (Ocm), which is predominately found in outer hair cells, leads to a progressive hearing loss after 1 month, suggesting that Ocm critically protects hearing in the mature ear

Doctoral Recital

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Water Use in the Eagle Ford Shale: An Economic and Policy Analysis of Water Supply and Demand

The Eagle Ford Shale is a massive geologic formation located in South Texas spanning 30 Texas counties from Brazos County in the north east to Webb County in the southwest . With the advent of hydraulic fracturing (HF) and horizontal drilling, over 200 operators have been able to tap into previously inaccessible shale reserves to p roduce abundant amounts of oil and gas. The oil and gas proliferation in the Eagle Ford has seen exponential growth , and production is not anticipated to decline until 2025. In addition, a typical HF well in the Eagle Ford is estimated to consume about 13 acre - feet of water for a standard 5000 foot lateral . Approximately 90% of water for HF comes from fresh groundwater aquifers. This interaction of HF and water consumption is of primary importance from a poli tical and economic perspective. This s erves as t he focal point of our report. Using the tools of statistics, our research considered the groundwater consumption trends within the Eagle Ford counties using water consumption data of municipal, irrigation, mining (oil and gas) and other categories over a span of four years . This analysis showed that fresh groundwater is being consumed at about 2.5 times the groundwater recharge rates . Furthermore, irrigation is using more water than all other water - consuming categories combined. Thus, the water problem reaches well beyond the use of fresh grou ndwater for mining . With respect to likely requirements of water for HF, we posited this question: “ W ill technology bail us out?” Retrofitting learning curves to our data for water uses and the length of the well la teral , we find that after i nitial improvements in water us age, the technology appears to have stabilized. This, coupled with massi ve irrigation water consumption suggests that technology will not be a major source of water savings in the long run. Instead, we must look to better public policies . From a policy perspective, the status quo for groundwater u se is governed by the Rule of Capture and the oversight of groundwater conservation districts (GCDs) . T here exists a real conflict as large - scale water users are competing for a diminishing aquifer resource with no market signals of increasing scarcity. In addition, groundwater wells drilled in connection with oil and gas exploration are exempt from GCD per mitting requirements and receive a de facto “free pass” to water for HF. Likewise, limita tions imposed on irrigation users by the GCDs are rarely binding, so these users usually get a free pass as well. Our analysis leads us to three basic policy recommend ations . The first involves mandatory reporting of all groundwater uses by all classes of water use r s. Currently, government agencies and the public lack basic information on actual water consumption; t his policy seeks to relax that knowledge gap and bring transparency. Second , we propose incentivizing oil and gas companies to substitute brackish groundwater for fresh ground water. Our proposal calls for a severance tax reduction for tho se companies limiting fresh groundwater use for HF in the Eagle Ford. In addition to a temporary reduction in the severance tax, these companies c ould be recognized by the RRC and possibly the TCEQ for their environmental stewardship with a “ Green Star ” designation. Our t hird , most heterodox and long - term recommendation is to define ground water property rights on a per - acre ownership basis, which would attach to the surface owner’s real property. Under this system, the owner s of the water rights would be able to sell their water as they would any other resource, and the market would adjust the price of water to an economically efficient level. Most importantly, it would remove the incentive to use all you can today , leaving more water for the future at a lower future price.Commissioner Christi Craddick, Texas Railroad Commissio

Doctoral Lecture-Recital

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Saxophone Studio Recital

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A Metabolomic Endotype of Bioenergetic Dysfunction Predicts Mortality in Critically Ill Patients with Acute Respiratory Failure

Acute respiratory failure (ARF) requiring mechanical ventilation, a complicating factor in sepsis and other disorders, is associated with high morbidity and mortality. Despite its severity and prevalence, treatment options are limited. In light of accumulating evidence that mitochondrial abnormalities are common in ARF, here we applied broad spectrum quantitative and semiquantitative metabolomic analyses of serum from ARF patients to detect bioenergetic dysfunction and determine its association with survival. Plasma samples from surviving and non-surviving patients (N = 15/group) were taken at day 1 and day 3 after admission to the medical intensive care unit and, in survivors, at hospital discharge. Significant differences between survivors and non-survivors (ANOVA, 5% FDR) include bioenergetically relevant intermediates of redox cofactors nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP), increased acyl-carnitines, bile acids, and decreased acyl-glycerophosphocholines. Many metabolites associated with poor outcomes are substrates of NAD(P)-dependent enzymatic processes, while alterations in NAD cofactors rely on bioavailability of dietary B-vitamins thiamine, riboflavin and pyridoxine. Changes in the efficiency of the nicotinamide-derived cofactors\u27 biosynthetic pathways also associate with alterations in glutathione-dependent drug metabolism characterized by substantial differences observed in the acetaminophen metabolome. Based on these findings, a four-feature model developed with semi-quantitative and quantitative metabolomic results predicted patient outcomes with high accuracy (AUROC = 0.91). Collectively, this metabolomic endotype points to a close association between mitochondrial and bioenergetic dysfunction and mortality in human ARF, thus pointing to new pharmacologic targets to reduce mortality in this condition

Gasless Laparoscopic Surgery for Minimally Invasive Surgery in Low-Resource Settings: Methods for Evaluating Surgical Field of View and Abdominal Wall Lift Force

Funder: Translate MedTec