Is Aprepitant Effective in Preventing Postoperative Nausea and Vomiting?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not aprepitant is effective in preventing postoperative nausea and vomiting. STUDY DESIGN: Review of three English language primary randomized controlled trials from 2012-2014. DATA SOURCES: Three double-blind, randomized controlled trials comparing oral aprepitant with placebo. All articles were found using PubMed. OUTCOMES MEASURED: The three studies measured nausea severity using a verbal rating system and number of episodes of nausea and vomiting recorded by a blinded study investigator. RESULTS: Vallejo et al found that 29.7% of the patients in the placebo group vomited compared to 9.3% of the patients who received aprepitant (p = 0.003). They also found that the worst VRS nausea score was a 5 out of 10 in the group of patients who received aprepitant versus 8 out of 10 for the placebo group (p = 0.014). Jung et al found that the groups that received aprepitant had a 35% incidence of nausea compared to 63% in the placebo group (p = 0.0025). In addition, the aprepitant groups both had 0% incidence of vomiting compared to the placebo group, which had a 20% incidence (p = 0.005). Sinha et al found that incidence of vomiting at 72 hours was 3.1% in the experimental group and 15.0% in the placebo group (p = 0.021). In all of the studies, mean VRS nausea scores were lower but were not found to be statistically significant. CONCLUSIONS: Aprepitant is effective in preventing incidence of nausea and vomiting, but is not found to significantly decrease average nausea rating scores

Contemporary Seismicity in and Around the Yakima Fold-and-Thrust Belt in Eastern Washington

We examined characteristics of routinely cataloged seismicity from 1970 to the present in and around the Yakima fold-and-thrust belt (YFTB) in eastern Washington to determine if the characteristics of contemporary seismicity provide clues about regional-scale active tectonics or about more localized, near-surface processes. We employed new structural and hydrologic models of the Columbia River basalts (CRB) and found that one-third to one-half of the cataloged earthquakes occur within the CRB and that these CRB earthquakes exhibit significantly more clustered, and swarmlike, behavior than those outside. These results and inferences from published studies led us to hypothesize that clustered seismicity is likely associated with hydrologic changes in the CRB, which hosts the regional aquifer system. While some general features of the regional groundwater system support this hypothesis, seismicity patterns and mapped long-term changes in groundwater levels and present-day irrigation neither support nor refute it. Regional tectonic processes and crustal-scale structures likely influence the distribution of earthquakes both outside and within the CRB as well. We based this inference on qualitatively assessed alignments between the dominant northwest trends in the geologic structure and the seismicity generally and between specific faults and characteristics of the 2009 Wooded Island swarm and aseismic slip, which is the only cluster studied in detail and the most vigorous since regional monitoring began.USGS-NAGTGeological Science

On Gender, Labor, and Inequality Ruth Milkman Urbana: University of Illinois Press, 2016 viii + 308 pp., 95.00(cloth);95.00 (cloth); 28.00 (paper); $25.20 (e-book)

In this scholarly tour de force, Ruth Milkman brings together four decades of sociological research on women workers to paint a portrait of gendered labor patterns from the Great Depression of the 1930s to the Great Recession of 2007–9. With meticulous research, careful argumentation, and effective writing, Milkman shows how economic actors—especially women workers, unions, and employers—shaped women\u27s employment and key industries of the US economy. As they managed changes in the labor and job markets, these actors both maintained strict job segregation by gender and transformed it, with implications for the dynamism and rigidity of gender roles in society more widely

Review Essay: Law and Migrant Labor in the 20th Century: Ghost Workers and Global Capitalism

Large-scale movements of workers, production lines, commodities, and centers of power have been integral to capitalist development since its earliest stages (see Mintz 1986; Wallerstein 2011; Wolf 1997). Today, mobility continues to uphold global capitalism in important respects (Sassen 1988). In particular, the capacity to move production across nation-state borders has allowed capitalist industries to take advantage of post-colonial inequalities as they reorganize production in ways and places that reduce manufacturing costs and enhance corporate profit..

Long-term results of the DelIVery for Pulmonary Arterial Hypertension trial

BACKGROUND: The DelIVery for Pulmonary Arterial Hypertension clinical trial was a multi-center, prospective, single arm, Investigational Device Exemption study utilizing a fully implantable, programmable intravascular delivery system consisting of a pump and a catheter for intravenous treprostinil. The study met its primary endpoint and demonstrated that the intravascular delivery system significantly reduced catheter related complications at 22,000 subject-days of follow-up compared with a predefined objective performance criterion. Here we summarize the results obtained during a 6.4-year follow-up period. METHODS: Throughout study follow-up, participants had clinic visits and medication refills at least every 12 weeks (dependent on the subjects\u27 dose). All adverse events and intravascular delivery system complications were evaluated and recorded. RESULTS: Sixty pulmonary arterial hypertension subjects were followed post device implantation for approximately 282 patient-years (range 87 days to 6.4 years). Of the 60 subjects, 14 died (1 related to intravascular delivery system pump failure), 2 withdrew after lung transplants, and 2 withdrew due to pump pocket infection. No catheter-related bloodstream infections, catheter thrombosis or occlusions, or catheter kinks occurred through 282 patient-years. Two participants had adverse events of abdominal pain, rash, due to subcutaneous treprostinil leaks after one catheter puncture and one catheter laceration during pump refill and replacement, respectively. Eight pump failure events occurred: seven pump motor stalls and one early replacement (faulty battery). CONCLUSION: Delivery of treprostinil with an intravascular delivery system is a safe alternative to an external delivery system, while providing enhanced life experiences. To preserve the risk-benefit ratio, treatment at specialized pulmonary arterial hypertension centers is recommended until training is disseminated at other sites

Evidence for Anthropogenic Surface Loading as Trigger Mechanism of the 2008 Wenchuan Earthquake

Two and a half years prior to China's M7.9 Wenchuan earthquake of May 2008, at least 300 million metric tons of water accumulated with additional seasonal water level changes in the Minjiang River Valley at the eastern margin of the Longmen Shan. This article shows that static surface loading in the Zipingpu water reservoir induced Coulomb failure stresses on the nearby Beichuan thrust fault system at <17km depth. Triggering stresses exceeded levels of daily lunar and solar tides and perturbed a fault area measuring 416+/-96km^2. These stress perturbations, in turn, likely advanced the clock of the mainshock and directed the initial rupture propagation upward towards the reservoir on the "Coulomb-like" Beichuan fault with rate-and-state dependent frictional behavior. Static triggering perturbations produced up to 60 years (0.6%) of equivalent tectonic loading, and show strong correlations to the coseismic slip. Moreover, correlations between clock advancement and coseismic slip, observed during the mainshock beneath the reservoir, are strongest for a longer seismic cycle (10kyr) of M>7 earthquakes. Finally, the daily event rate of the micro-seismicity (M>0.5) correlates well with the static stress perturbations, indicating destabilization.Comment: 22 pages, 4 figures, 3 table

The Relationship Between Alcohol Symptoms and Consumption Among Older Drinkers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66310/1/j.1530-0277.1996.tb01104.x.pd

Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension

<p>Abstract</p> <p>Background</p> <p>Late gadolinium enhancement (LGE) occurs at the right ventricular (RV) insertion point (RVIP) in patients with pulmonary hypertension (PH) and has been shown to correlate with cardiovascular magnetic resonance (CMR) derived RV indices. However, the prognostic role of RVIP-LGE and other CMR-derived parameters of RV function are not well established. Our aim was to evaluate the predictive value of contrast-enhanced CMR in patients with PH.</p> <p>Methods</p> <p>RV size, ejection fraction (RVEF), and the presence of RVIP-LGE were determined in 58 patients with PH referred for CMR. All patients underwent right heart catheterization, exercise testing, and N-terminal pro-brain natriuretic peptide (NT-proBNP) evaluation; results of which were included in the final analysis if performed within 4 months of the CMR study. Patients were followed for the primary endpoint of time to clinical worsening (death, decompensated right ventricular heart failure, initiation of prostacyclin, or lung transplantation).</p> <p>Results</p> <p>Overall, 40/58 (69%) of patients had RVIP-LGE. Patients with RVIP- LGE had larger right ventricular volume index, lower RVEF, and higher mean pulmonary artery pressure (mPAP), all p < 0.05. During the follow-up period of 10.2 ± 6.3 months, 19 patients reached the primary endpoint. In a univariate analysis, RVIP-LGE was a predictor for adverse outcomes (p = 0.026). In a multivariate analysis, CMR-derived RVEF was an independent predictor of clinical worsening (p = 0.036) along with well-established prognostic parameters such as exercise capacity (p = 0.010) and mPAP (p = 0.001).</p> <p>Conclusions</p> <p>The presence of RVIP-LGE in patients with PH is a marker for more advanced disease and poor prognosis. In addition, this study reveals for the first time that CMR-derived RVEF is an independent non-invasive imaging predictor of adverse outcomes in this patient population.</p

Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations

The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. Methods A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. Results The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. Conclusion Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe retur