Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block

Local infiltration analgesia (LIA) is a new multimodal wound infiltration method. It has attracted growing interest in recent years and is widely used all over the world for treating postoperative pain after knee and hip arthroplasty. This method is based on systematic infiltration of a mixture of ropivacaine, a long acting local anesthetic, ketorolac, a cyclooxygenase inhibitor (NSAID), and adrenalin around all structures subject to surgical trauma inknee and hip arthroplasty. Two patient cohorts of 40 patients scheduled for elective total knee arthroplasty (TKA) and 15 patients scheduled for total hip arthroplasty (THA) contributed to the work presented in this thesis. In a randomized trial the efficacy of LIA in TKA with regard to pain at rest and upon movement was compared to femoral block. Both methods result in a high quality pain relief and similar morphine consumption, but fewer patients in the LIA group reported pain of 7/10 on any occasion during the 24 h monitoring period (paper I). In the same patient cohort the maximal total plasma concentration of ropivacaine was below the established toxic threshold for most patients although a few reached potentially toxic concentrations of 1.4-1.7 mg/L. The time to maximal detected plasma concentration was around 4-6 h after release of tourniquet in TKA (paper II). All patients in the THA cohort were subjected to the routine LIA protocol. In these patients both the total and unbound plasma concentration of ropivacaine was determined. The concentration was below the established toxic threshold. As ropivacaine binds to a-1 acid glycoprotein(AAG) we assessed the possibility that increased AAG may decrease the unbound concentration of ropivacaine. A40 % increase in AAG was detected during the first 24 h after surgery, however the fraction of unbound ropivacaine remained the same. There was a trend towards increased C max of ropivacaine with increasing age and decreasing creatinine clearance but the statistical power was too low to draw any conclusion (paper III). Administration of 30mg ketorolac according to the LIA protocol both in TKA and THA resulted in a similar Cmax as previously reported after 10 mg intramuscular ketorolac (paper II, paper IV). Neither age, nor body weight or BMI, nor creatinine clearance, correlates to maximal ketorolac plasma concentration or total exposure to ketorolac (AUC) (paper IV). In conclusion, LIA provides good postoperative analgesia which is similar to femoral block after total knee arthroplasty. The plasma concentration of ropivacaine seems to be below toxic levels in most TKA patients. The unbound plasma concentration of ropivcaine in THA seems to be below the toxic level. The use of ketorolac in LIA may not be safer than other routes of administration, and similar restrictions should be applied in patients at risk of developing side effects

The Ecological Future of the North American Bison: Conceiving Long-Term, Large-Scale Conservation of Wildlife

Many wide-ranging mammal species have experienced significant declines over the last 200 years; restoring these species will require long-term, large-scale recovery efforts. We highlight 5 attributes of a recent range-wide vision-setting exercise for ecological recovery of the North American bison (Bison bison) that are broadly applicable to other species and restoration targets. The result of the exercise, the “Vermejo Statement” on bison restoration, is explicitly (1) large scale, (2) long term, (3) inclusive, (4) fulfilling of different values, and (5) ambitious. It reads, in part, “Over the next century, the ecological recovery of the North American bison will occur when multiple large herds move freely across extensive landscapes within all major habitats of their historic range, interacting in ecologically significant ways with the fullest possible set of other native species, and inspiring, sustaining and connecting human cultures.” We refined the vision into a scorecard that illustrates how individual bison herds can contribute to the vision. We also developed a set of maps and analyzed the current and potential future distributions of bison on the basis of expert assessment. Although more than 500,000 bison exist in North America today, we estimated they occupy \u3c1% of their historical range and in no place express the full range of ecological and social values of previous times. By formulating an inclusive, affirmative, and specific vision through consultation with a wide range of stakeholders, we hope to provide a foundation for conservation of bison, and other wide-ranging species, over the next 100 years

In situ induction of dendritic cell–based T cell tolerance in humanized mice and nonhuman primates

Administration of an ICAM-1–specific antibody arrests dendritic cells in a semi-immature state and facilitates antigen-specific T cell tolerance to islet allografts in humanized mice and Rhesus monkeys

The adoption of pottery on Kodiak Island: Insights from organic residue analysis

Pottery technology, originating in Northeast Asia, appeared in Alaska some 2800 years ago. It spread swiftly along Alaska’s coastline but was not adopted on Kodiak Island until around 500 cal BP, as part of the Koniag tradition. While in the southeast pottery was used extensively, people on the northern half of the island did not adopt the technology. What drove these patterns of adoption and non-adoption on Kodiak Island? To better understand the role of ceramic technology in the Koniag tradition we used organic residue analysis to investigate pottery function. Results indicate that pottery was used to process aquatic resources, including anadromous fish, but especially marine species. Based on archaeological and ethnographic data, and spatial analysis of pottery distributions and function, we hypothesize that Koniag pottery was a tool inherent to the rendering of whale oil on the southeast coast of Kodiak Island, supporting previous suggestions by Knecht (1995) and Fitzhugh (2001). When viewed in the broader historical context of major technological and social transformations, we conclude that social identity and cultural boundaries may also have played a role in the delayed and partial adoption of pottery on Kodiak Island

Structure, problems and possibilities for their solution in external evaluation of colleges

The article grounds the structure of the external evaluation of colleges at the level of the non-university higher education sector, and it reveals the problems met in this process as well as possibilities for their solution: the phenomenon of the external evaluation of colleges is discussed and its concept is presented; the external evaluation process of the European higher schools is analysed and its stages are described; the problems and possibilities for their solution in the external evaluation of Lithuanian colleges are presented in the views of those participating in the evaluatio

Structure, problems and possibilities for their solution in external evaluation of colleges

Straipsnyje pagrindžiama kolegijų išorinio įvertinimo struktūra aukštojo neuniversitetinio mokslo sektoriuje, atskleidžiamos šio proceso metu kylančios problemos ir jų sprendimo galimybės: aptariamas kolegijų išorinio įvertinimo reiškinys ir pateikiama jo samprata; analizuojamas Europos aukštųjų mokyklų išorinio įvertinimo procesas ir apibūdinami jį sudarantys etapai; taip pat pristatomos Lietuvos kolegijų išorinio įvertinimo metu kylančios problemos ir jų sprendimo galimybės įvertinime dalyvaujančių asmenų požiūriuThe article grounds the structure of the external evaluation of colleges at the level of the non-university higher education sector, and it reveals the problems met in this process as well as possibilities for their solution: the phenomenon of the external evaluation of colleges is discussed and its concept is presented; the external evaluation process of the European higher schools is analysed and its stages are described; the problems and possibilities for their solution in the external evaluation of Lithuanian colleges are presented in the views of those participating in the evaluationEdukologijos tyrimų institutasStudijų kokybės vertinimo centrasVytauto Didžiojo universiteta

A qualitative study examining the validity and comprehensibility of physical activity items: developed and tested in children with juvenile idiopathic arthritis

Abstract Background Not all physical activity (PA) questionnaires (PAQ) gather information regarding PA intensity, duration, and modes and only a few were developed specifically for children. We assessed children’s comprehensibility of items derived from two published PAQs used in children along with three items designed to ascertain PA intensity in order to assess comprehensibility of items and identify response errors. We modified items to create a new PAQ for children (ASCeND). We hypothesized that children would have comprehension difficulties with some original PAQ items and that ASCeND would be easier to comprehend, and would improve recall and reporting of PA. Methods For this qualitative study, we recruited 30 Swedish children [ages 10–16 years; mean age = 13.0 (SD = 1.8)]; median disease activity score = 4.5 (IQR 2.2–9.0); median disease duration = 5.0 (IQR 2.6–10.8) with juvenile idiopathic arthritis (JIA) from a children’s hospital-based rheumatology clinic. We conducted cognitive interviews to identify children’s comprehension of PAQ items. Interviews were audiotaped, transcribed, and independently analyzed. In phase one, 10 children were interviewed and items modified based on feedback. In phase two, an additional 20 children were interviewed to gather more feedback and further refine the modified items, to create the ASCeND. Results The median interview time was 41 min (IQR 36–56). In phase one, 219 comments were generated regarding directions for recording PA duration, and transportation use, walking, dancing, weight-bearing exercise and cardio fitness. Based on feedback we modified the survey layout, clarified directions and collapsed or defined items to reduce redundancy. In phase two, 95 comments were generated. Most comments related to aerobic fitness and strenuous PA. Children had difficulty recalling total walking and other activities per day. Children used the weather on a particular day, sports practice, or gym schedules to recall time performing activities. The most comments regarding comprehension were generated about the 3-item PA intensity survey, suggesting children had problems responding to intensity items. Conclusions The newer layout facilitated recall of directions or efficiency in answering items. The 3-item intensity survey was difficult to answer. Sports-specific items helped children more accurately recall the amount of daily PA. The ASCeND appeared to be easy to answer and to comprehend