Effects of Metoclopramide and Ranitidine on Preoperative Gastric Contents in Day-Case Surgery

This prospective, randomized, double-blinded study was performed to evaluate the effects of intravenous metoclopramide and ranitidine on preoperative gastric contents in outpatients receiving intravenous anesthesia for laparoscopic gynecologic surgery. Fifteen minutes before the induction of anesthesia, the Z-M group (n = 20) received 50 mg ranitidine and 10 mg metoclopramide intravenously and the control group (n = 20) received the same volume of normal saline. Before the surgery, a 14-F multiorifice nasogastric tube was inserted to aspirate the gastric contents of patients under sedation with propofol and midazolam. The mean pH values of the gastric fluid were 2.7 ± 2.0 (SD) [median 1.6 (range: 1.2-7.2)] in the control group, and 6.1 ± 1.9 [median 6.8 (range 1.4-7.8)] in the Z-M group. The mean aspirated volumes (mL) were 15.3 ± 10.4 (SD) [median 11.0 (range: 5.0-44.0)] in the control group, and 6.9 ± 10.0 (SD) [median 4.5 (range: 0-38.0)] in the Z-M group. There were significantly more high-risk (gastric fluid volumes > 25 mL and pH < 2.5) patients in the control group (4/20, 20%) than in the Z-M group (1/20, 5%). In conclusion, intravenous prophylactic ranitidine and metoclopramide may be an easy and useful method to decrease the volume while increasing the pH of gastric contents, and therefore may reduce the number of patients at risk for aspiration pneumonitis in ambulatory laparoscopic procedures who receive an anesthesia

Evaluation of microwave sensor for soil moisture content determination

Real-time knowledge of soil moisture content and its variability during earthwork construction operations could have tremendous impact on process control (i.e. fill placement, disking, compaction, etc.) and the resulting fill quality. A means of rapidly determining soil moisture content using an off-the-shelf microwave sensor (Hydronix Hydro-Mix VI) is described in this report. The sensor provides an analogue output of 4 to 20 mA and is scaled to report zero in air and 100 in water. The sensor is placed in contact with the soil and has a measure up to about 100 mm. The sampling rate is 25 Hz, but usually takes 2 to 3 seconds to stabilize. The operating temperature is 0 to 60°C.;The purpose of this phase of the study was to develop relations between the microwave value (MV) and gravimetric moisture content of the soil in the laboratory, although some field tests were also performed. Tests were performed using several different soil types at different compaction efforts and at a wide range of moisture contents on the wet and dry sides of optimum moisture contents. The MV values from the sensor are correlated with oven dry moisture contents. In short, low values of standard deviation, standard error and coefficient of variation in the microwave data indicate that the precision in the measurements is high. Microwave sensor proved to be a very useful instrument for fast and accurate soil moisture content determination. The findings are promising and warrant further evaluation and development.;Some of the key findings and observations from the study are as follows: (1) The standard laboratory mold dielectric is found to have a significant effect on the MVs and should not be used for laboratory calibration. (2) The MV value is sensitive to small changes in contact area of the sensor. The maximum allowable change in surface area of a specimen compacted on the wet of optimum is found to be 3cm2. (3) The height up to which the steel plate dielectric affects a microwave value of an extracted soil specimen resting on the plate is about 50 mm. (4) The suitability of the microwave sensor for five different soils, namely Edward Till, Kickapoo Clay, Kickapoo Topsoil and FA6 and CA6G were studied both at ISU laboratory and in the test beds at Caterpillar\u27s soil mechanic lab. Regression analysis showed that R2 values from linear relationships ranged from 0.87 to 0.98. (5) Statistical models were developed based on soil type using the laboratory data. MV and MV2 terms proved to be the most significant parameters affecting the models---dry density and various soil index parameters were also considered and in some cases were significant. Using just the MV terms in the statistical analysis results in predication models can be improved. (6) Accuracy and precision tests on Edwards till samples compacted at -3%, 0%, and +2% of standard Proctor optimum moisture content produced standard deviations of 0.4 to 0.6%. The standard error of the mean was 0.06 to 0.08%. For Loess samples compacted at -3%, 0%, and +2% of standard Proctor optimum moisture content, the standard deviations varied from 0.2 and 0.3% and the standard errors are from 0.03 to 0.05. At a 95% confidence interval the predictions are within +/-1%, which meeting the target established for this research.;The low values of standard deviation, standard error and coefficient of variation in the microwave data indicate that the precision in the measurements is high. Microwave sensor proved to be a very useful instrument for fast and accurate soil moisture content determination

Recovery Housing in the United States and the Importance of Data Collection

Substance use disorder (SUD) has been a prevalent issue in both the clinical and public health sectors for some time. Substance use disorder can be defined as a disease that affects an individual’s brain and behavior, causing them to develop an inability to control the use of legal or illegal drugs and substances (Mayo Clinic, 2021). Substances include but are not limited to alcohol, marijuana, opioids, and other controlled substances (Mayo Clinic, 2021). Substance misuse is a large topic of focus in public health because it not only deteriorates the quality of health in individuals and society, but also comes with large financial burdens, and also affects the educational and built social systems in the United States (Mclellan, 2017). In 2019, a study found that drug overdose deaths more than tripled in 2 decades at an alarming number of 70,000 deaths in one year (Peterson, Li, Xu, Mikosz, & Luo, 2021). This statistic in itself should be alarming. However, the burden of substance use disorder can be further exemplified in the burden it has had on the economy in the country as well. Substance use disorder has been estimated to cost a total of $420 billion annually and an additional$120 billion in associated healthcare and medical care costs (Mclellan, 2017). The size and burden of this disease is alarming and very evident, and while there has been much time and effort dedicated towards creating effective and lasting treatment for substance use disorder, work is still needed in this area. According to the National Institute on Drug Abuse, a division of the National Institutes of Health, principles of effective treatment include addressing all of the patients’ needs and not just the drug use, including an aspect of counseling or behavior therapy, addressing the possibility of other mental disorders, and creating a safe and welcoming space that fosters effective treatment (National Institute on Drug Abuse (NIDA), 2019). In this same report, a list of successful methods in treating substance use disorder was also provided, and it included: behavioral counseling, medication, medical devices and applications to treat withdrawal symptoms, and evaluation and treatment for co-occurring mental health issues (NIDA, 2019). However, health care professionals and providers of substance misuse treatment in the United States are recognizing the limitations of acute and inpatient care models that are currently available to treat the disorder (Polcin, 2015). Long term services to sustain recovery over time are necessary. Residential recovery homes, also known as sober living houses, are substance free living environments that provide long-term support for individuals with addiction and substance use disorders (Polcin, 2015). Individuals suffering from this disease generally lack environments that support sustained recovery by providing a substance free environment. The purpose of this analysis was to gather information on the types of data that are currently collected in recovery housing. Knowing this information is vital as information on the demographics of residents, house and bed availability, populations served, and the number of individuals receiving long-term care for substance use disorders in recovery residents can guide funding for the recovery ecosystem. More funding for recovery means more accessibility and addressing this disorder on a larger scale

Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

BACKGROUND: Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. METHODS: Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting. RESULTS: The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine. CONCLUSION: This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain

Explosive growth of facet joint interventions in the medicare population in the United States: a comparative evaluation of 1997, 2002, and 2006 data

<p>Abstract</p> <p>Background</p> <p>The Office of Inspector General of the Department of Health and Human Services (OIG-DHHS) issued a report which showed explosive growth and also raised questions of lack of medical necessity and/or indications for facet joint injection services in 2006.</p> <p>The purpose of the study was to determine trends of frequency and cost of facet joint interventions in managing spinal pain.</p> <p>Methods</p> <p>This analysis was performed to determine trends of frequency and cost of facet joint</p> <p>Interventions in managing spinal pain, utilizing the annual 5% national sample of the Centers for</p> <p>Medicare and Medicaid Services (CMS) for 1997, 2002, and 2006.</p> <p>Outcome measures included overall characteristics of Medicare beneficiaries receiving facet joint interventions, utilization of facet joint interventions by place of service, by specialty, reimbursement characteristics, and other variables.</p> <p>Results</p> <p>From 1997 to 2006, the number of patients receiving facet joint interventions per 100,000</p> <p>Medicare population increased 386%, facet joint visits increased 446%, and facet joint interventions increased 543%. The increases were higher in patients aged less than 65 years compared to those 65 or older with patients increasing 504% vs. 355%, visits increasing 587% vs. 404%, and services increasing 683% vs. 498%.</p> <p>Total expenditures for facet joint interventions in the Medicare population increased from over $229 million in 2002 to over$511 million in 2006, with an overall increase of 123%. In 2006, there was a 26.8-fold difference in utilization of facet joint intervention services in Florida compared to the state with the lowest utilization - Hawaii.</p> <p>There was an annual increase of 277.3% in the utilization of facet joint interventions by general physicians, whereas a 99.5% annual increase was seen for nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs) from 2002 to 2006. Further, in Florida, 47% of facet joint interventions were performed by general physicians.</p> <p>Conclusions</p> <p>The reported explosive growth of facet joint interventions in managing spinal pain in certain regions and by certain specialties may result in increased regulations and scrutiny with reduced access.</p

Cervical Facet Joint Injections in the Neck and Shoulder Pain

The effects from cervical facet joint injections in those patients who have been complaining cervical zygapophyseal joint pain were compared. The patients were diagnosed originally as myofascial pain syndrome (MPS), cervical herniated nucleus pulposus (HNP), and whiplash-associated disorders (WAD). Patients with the zygapophyseal joints pain of C5-6 and C6-7 were classified by their pain origin as MPS, HNP, and WAD. All patients had been undergone cervical zygapophyseal joints injections with the mixture of lidocaine and triamcinolone unilaterally or bilaterally through the posterior approach under C-arm imaging guide. The therapeutic effects were compared with reduction of numeric rating scale (NRS) of pain before and immediately after blockade and symptom-free periods in each group after 12 months. Symptom durations before injections were 16.1±9.6, 4.6±1.9 and 4.1±1.1 months in each MPS, HNP, and WAD groups. The reductions of NRS immediately after the blockade among the three groups were not different. However, the symptom-free duration after blockade lasted longer in the HNP group than the other two groups. In patients with cervical zygapophyseal pain syndromes, the analgesic effect from cervical facet joint blocks lasted longer in cervical HNP than MPS or WAD

Community-level intimate partner violence and the circumstances of first sex among young women from five African countries

<p>Abstract</p> <p>Background</p> <p>Gender-based violence is an important risk factor for adverse reproductive health (RH). Community-level violence may inhibit young women's ability to engage in safer sexual behaviors due to a lack of control over sexual encounters. Few studies examine violence as a contextual risk factor.</p> <p>Methods</p> <p>Using nationally representative data from five African countries, the association between community-level physical or sexual intimate partner violence (IPV) and the circumstances of first sex (premarital or marital) among young women (ages 20-29) was examined.</p> <p>Results</p> <p>In Mali, and Kenya bivariate analyses showed that young women who had premarital first sex were from communities where a significantly higher percentage of women reported IPV experience compared to young women who had marital first sex. Multivariate analyses confirmed the findings for these two countries; young women from communities with higher IPV were significantly more likely to have had premarital first sex compared to first sex in union. In Liberia, community-level IPV was associated with a lower risk of premarital sex as compared to first sex in union at a marginal significance level. There was no significant relationship between community-level IPV and the circumstances of first sex in the Democratic Republic of Congo or Zimbabwe.</p> <p>Conclusion</p> <p>These findings indicate that context matters for RH. Individualized efforts to improve RH may be limited in their effectiveness if they do not acknowledge the context of young women's lives. Programs should target prevention of violence to improve RH outcomes of youth.</p