Comparing postoperative pain scores and opioid consumption in patients receiving Lumbar Plexus block versus Fascia Iliaca block after undergoing hip arthroplasty

Background and Review of Literature: Lumbar plexus block and fascia iliaca block are two commonly used anesthesia modalities for patients underdoing hip arthroplasty at Union Hospital in Terre Haute, Indiana. Currently, there are not any studies that demonstrate which block is more effective at reducing postoperative pain and opioid consumption after hip arthroplasty. Review of literature demonstrates that both blocks have their advantages and disadvantages for providing postoperative pain relief. Purpose: To determine which block is more effective at reducing postoperative pain, opioid consumption, and length of stay in hospital after hip arthroplasty procedures. These findings will then be presented to anesthesia staff at Union Hospital. Methods: A retrospective chart review will be conducted on 25 patients that received a lumbar plexus block and 25 that received facia iliaca block. Pain scores and opioids consumed will be calculated for each patient in each group to determine which block provides superior pain relief. Overall length of stay will be calculated for each block group as well. Microsoft Excel and SigmaXL were utilized to analyze the data. ClinCalc opioid equivalent calculator was utilized to convert all opioids administered into intravenous morphine milliequivalents Conclusion: This project demonstrated that the fascia iliaca block was superior at reducing postoperative pain (P = 0.045) in PACU as well as reducing overall opioid consumption (P = 0.0056) when compared to the lumbar plexus block. However, length of stay in hospital and pain score at 24 hours were similar. Difficulty of block and anesthesia provider experience must also be considered

Privacy through Pseudonymity in Mobile Telephony Systems

Abstract—To protect mobile phone from tracking by third parties, mobile telephony systems rely on periodically changing pseudonyms. We experimentally and formally analyse the mechanism adopted to update these pseudonyms and point out design and implementation weaknesses that defeat its purpose by allowing the identification and/or tracking of mobile telephony users. In particular, the experiments show that the pseudonym changing mechanism as implemented by real networks does not achieve the intended privacy goals. Moreover, we found out that the standard is flawed and that it is possible to exploit the procedure used to assign a new pseudonym, the TMSI reallocation procedure, in order to track users. We propose countermeasures to tackle the exposed vulnerabilities and formally prove that the 3GPP standard should require the establishment of a fresh ciphering key before each execution of the TMSI reallocation procedure to provide unlinkability. I

Reassessing the Green Paradox

This paper deals with possible foreign reactions to domestic carbon demand reducing policies. It differentiates between demand side and supply side reactions as well as between intra- and intertemporal shifts of greenhouse gas emissions. In our model, we integrate increasing marginal physical extraction costs of fossil fuels into the general equilibrium carbon leakage model of Eichner & Pethig (2011). The results are as follows: The conditions for the emergence of the weak green paradox are similar but somewhat tighter than those derived by Eichner & Pethig (2011). Additionally, a strong green paradox can arise in our model under supplemental constraints. That means a "green" policy measure might not only lead to an acceleration of fossil fuel extraction but to an increase in the cumulative extraction

Unilateral Climate Policy: Harmful or even Disastrous?

This paper deals with possible foreign reactions to unilateral carbon demand reducing policies. It differentiates between demand side and supply side reactions as well as between intra- and intertemporal shifts in greenhouse gas emissions. In our model, we integrate a stock-dependent marginal physical cost of extracting fossil fuels into Eichner & Pethig\u27s (2011) general equilibrium carbon leakage model. The results are as follows: Under similar but somewhat tighter conditions than those derived by Eichner & Pethig (2011), a weak green paradox arises. Furthermore, a strong green paradox can arise in our model under supplementary constraints. That means a "green" policy measure might not only lead to a harmful acceleration of fossil fuel extraction but to an increase in the cumulative climate damages at the same time. In some of these cases there is even a cumulative extraction expansion, which we consider disastrous

On the Nature of Ultra-Luminous X-ray Sources from Optical/IR Measurements

We present a model for the prediction of the optical/infra-red emission from ULXs. In the model, ULXs are binary systems with accretion taking place through Roche lobe overflow. We show that irradiation effects and presence of an accretion disk significantly modify the optical/infrared flux compared to single stars, and also that the system orientation is important. We include additional constraints from the mass transfer rate to constrain the parameters of the donor star, and to a lesser extent the mass of the BH. We apply the model to fit photometric data for several ULX counterparts. We find that most donor stars are of spectral type B and are older and less massive than reported elsewhere, but that no late-type donors are admissable. The degeneracy of the acceptable parameter space will be significantly reduced with observations over a wider spectral range, and if time-resolved data become available

On voxel-by-voxel accumulated dose for prostate radiation therapy using deformable image registration.

Since delivered dose is rarely the same with planned, we calculated the delivered total dose to ten prostate radiotherapy patients treated with rectal balloons using deformable dose accumulation (DDA) and compared it with the planned dose. The patients were treated with TomoTherapy using two rectal balloon designs: five patients had the Radiadyne balloon (balloon A), and five patients had the EZ-EM balloon (balloon B). Prostate and rectal wall contours were outlined on each pre-treatment MVCT for all patients. Delivered fractional doses were calculated using the MVCT taken immediately prior to delivery. Dose grids were accumulated to the last MVCT using DDA tools in Pinnacle3 TM (v9.100, Philips Radiation Oncology Systems, Fitchburg, USA). Delivered total doses were compared with planned doses using prostate and rectal wall DVHs. The rectal NTCP was calculated based on total delivered and planned doses for all patients using the Lyman model. For 8/10 patients, the rectal wall NTCP calculated using the delivered total dose was less than planned, with seven patients showing a decrease of more than 5% in NTCP. For 2/10 patients studied, the rectal wall NTCP calculated using total delivered dose was 2% higher than planned. This study indicates that for patients receiving hypofractionated radiotherapy for prostate cancer with a rectal balloon, total delivered doses to prostate is similar with planned while delivered dose to rectal walls may be significantly different from planned doses. 8/10 patients show significant correlation between rectal balloon anterior-posterior positions and some VD values

Situating the Georgia Performance Standards in the Social Studies Debate: An Improvement for Social Studies Classrooms or Continuing the Whitewash

After approximately two decades of using the Quality Core Curriculum, in 2005 the State of Georgia began the process of implementing the new Georgia Performance Standard. In this article the authors examine the strengths and weaknesses of this new curriculum, along with the proposed model of implementation. In this examination, the authors will attempt to situate both the standards and their implementation within the current political struggle over curriculum in the United States

Chest Swelling and Fever in an Intravenous Drug User

This case report describes a sternoclavicular infection in an IV drug user. The history and physical exam suggested an abscess. In the emergency department (ED) the patient refused incision and drainage but did consent to simple needle aspiration. Subsequent culture of the aspirate revealed Pseudomonas aeruginosa. He was admitted for IV antibiotics. After admission, a bone scan suggested the presence of osteomyelitis. The patient refused operative débridement, but ultimately did consent to bedside incision and drainage. By day five, the fever had resolved and the patient signed out AMA. He was given a prescription for Ciprofloxacin. The patient had an unscheduled follow up in the ED five months later for an unrelated heroin overdose. Physical examination demonstrated complete resolution of the infection