A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery.

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients\u27 pain experience and opioid consumption after carpal tunnel release (CTR) surgery. METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded. RESULTS: During the day of surgery and the first day following surgery, patients in the group with counseling reported significantly fewer prescribed opioid pills consumed compared with patients in the group without counseling, while experiencing no significant difference in pain level experience. In addition, patients in the group with counseling reported a significantly lower number of total pain pills consumed over the course of the study than the group without counseling. No major adverse reactions were noted in either group. CONCLUSIONS: Preoperative opioid counseling was found to result in a significant decrease in overall opioid consumption after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures. The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods. Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating. Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal. Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates

ELITE GERMPLASM FOR GMO'S IN BRAZIL: MODELING GOVERNMENT-AGRIBUSINESS NEGOTIATIONS

Advances in agricultural biotechnology have led to interest by agribusiness to license elite germplasm from national programs in developing countries, now in need of funds. Uncertainties about the value of the material have delayed negotiations. This article proposes a method of setting upper (monopoly; no seed saving) and lower (competitive) negotiating bounds on values. The model accounts for (1) annual productivity enhancements, (2) effects on world prices, and (3) obsolescence effects of greater R&D. A demonstration application for soybeans in Brazil, which has completed the preconditions (IPR, biosafety, internal policy), suggests limited private value for public germplasm. The optimal solution is cooperation (licensing).Agribusiness, Research and Development/Tech Change/Emerging Technologies,

O VI and Multicomponent H I Absorption Associated with a Galaxy Group in the Direction of PG0953+415: Physical Conditions and Baryonic Content

We report the discovery of an O VI absorption system at z(abs) = 0.14232 in a high resolution FUV spectrum of PG0953+415 obtained with the Space Telescope Imaging Spectrograph (STIS). Both lines of the O VI 1032, 1038 doublet and multicomponent H I Lya absorption are detected, but the N V doublet and the strong lines of C II and Si III are not apparent. We examine the ionization mechanism of the O VI absorber and find that while theoretical considerations favor collisional ionization, it is difficult to observationally rule out photoionization. If the absorber is collisionally ionized, it may not be in equilibrium due to the rapid cooling of gas in the appropriate temperature range. Non-equilibrium collisionally ionized models are shown to be consistent with the observations. A WIYN survey of galaxy redshifts near the sight line has revealed a galaxy at a projected distance of 395 kpc separated by ~130 km/s from this absorber, and three additional galaxies are found within 130 km/s of this redshift with projected separations ranging from 1.0 Mpc to 3.0 Mpc. Combining the STIS observations of PG0953+415 with previous high S/N GHRS observations of H1821+643, we derive a large number of O VI absorbers per unit redshift, dN/dz ~20. We use this sample to obtain a first estimate of the cosmological mass density of the O VI systems at z ~ 0. If further observations confirm the large dN/dz derived for the O VI systems, then these absorbers trace a significant reservoir of baryonic matter at low redshift.Comment: Accepted for publication in Ap.J., vol. 542 (Oct. 10, 2000

Statistical stability of equilibrium states for interval maps

We consider families of multimodal interval maps with polynomial growth of the derivative along the critical orbits. For these maps Bruin and Todd have shown the existence and uniqueness of equilibrium states for the potential $\phi_t:x\mapsto-t\log|Df(x)|$, for $t$ close to 1. We show that these equilibrium states vary continuously in the weak$^*$ topology within such families. Moreover, in the case $t=1$, when the equilibrium states are absolutely continuous with respect to Lebesgue, we show that the densities vary continuously within these families.Comment: More details given and the appendices now incorporated into the rest of the pape

Development of composite ionizer materials final report

Composite ionizer materials - effect of secondary additions to tungsten powder on sintering mechanisms and heat stability of porous structure

Hypoconstrained Jammed Packings of Nonspherical Hard Particles: Ellipses and Ellipsoids

Continuing on recent computational and experimental work on jammed packings of hard ellipsoids [Donev et al., Science, vol. 303, 990-993] we consider jamming in packings of smooth strictly convex nonspherical hard particles. We explain why the isocounting conjecture, which states that for large disordered jammed packings the average contact number per particle is twice the number of degrees of freedom per particle (\bar{Z}=2d_{f}), does not apply to nonspherical particles. We develop first- and second-order conditions for jamming, and demonstrate that packings of nonspherical particles can be jammed even though they are hypoconstrained (\bar{Z}<2d_{f}). We apply an algorithm using these conditions to computer-generated hypoconstrained ellipsoid and ellipse packings and demonstrate that our algorithm does produce jammed packings, even close to the sphere point. We also consider packings that are nearly jammed and draw connections to packings of deformable (but stiff) particles. Finally, we consider the jamming conditions for nearly spherical particles and explain quantitatively the behavior we observe in the vicinity of the sphere point.Comment: 33 pages, third revisio