Benefits of thoracic epidural analgesia in patients undergoing an open posterior component separation for abdominal herniorrhaphy

INTRODUCTION: The implementation of open posterior component separation (PCS) surgery has led to improved outcomes for complex hernias. While the PCS technique has been shown to decrease recurrence rates, and provide a feasible option to repair hernias in nontraditional locations, there is still significant postoperative pain associated with the laparotomy and extensive abdominal wall manipulation. Systemic opioids and thoracic epidural analgesia (TEA) are both commonly utilized, either together or independently, as postoperative analgesic regimens. The benefits of TEA have been studied following a variety of surgeries, however to date no study has been performed to investigate its efficacy in this particular surgery. The aim of this study is to evaluate the benefits of TEA following open PCS. We hypothesized that the incorporation of TEA in a patients postoperative analgesic regimen would show an advantage in time to bowel recovery. METHODS: An electronic medical record query was done to identify patients who had undergone an open PCS. Once this list was compiled, a retrospective chart review was performed and patients receiving TEA (either alone or combined with systemic opioids) were compared to patients receiving only systemic opioids. The primary endpoint compared time to resumption of a full diet, given by the patients postoperative day (POD). Secondarily, time to resumption of a liquid diet, postoperative length of stay (LOS), intensive care unit (ICU) admission rate, ICU LOS, and rates of several postoperative complications were all recorded and compared. A post-hoc analysis was also performed using the same endpoints. This analysis compared cohorts of patients receiving TEA and avoiding all systemic opioids, to patients who received systemic opioids (whether alone or combined with TEA). RESULTS: Based on inclusion parameters, 101 patients met criteria for analysis. In the initial analysis, 62 patients received TEA with or without systemic opioids, and 39 patients received only systemic opioids. In comparing these groups, there was no statistically significant difference in time to full diet (TEA 2.6 ± 1.7 vs Systemic opioids 3.1 ± 2.1 [mean POD ± SD]; P=0.21). In addition, no differences were found in the secondary outcomes of time to liquid diet, ICU admission, ICU LOS, or postoperative complications. In the post-hoc analysis, the 37 patients that received only TEA, were compared against 64 patients that received systemic opioids (either with or without TEA). In this comparison, the group receiving only TEA was found to have a statically shorter time to bowel recovery compared to patients receiving systemic opioids (TEA alone 2.2 ± 1.0 vs Systemic opioids 3.2 ± 2.2, P=0.0033). This subgroup (TEA only) also showed statically shorter time to liquid diet and a decreased postoperative LOS. CONCLUSION: For patients undergoing an open PCS, the inclusion of TEA in the postoperative analgesic regimen did not shorten return of bowel function. However, when TEA was utilized and systemic opioids were avoided, time to bowel recovery and hospital LOS were both significantly shortened

Election Law and White Identity Politics

The role of race in American politics looms large in several election law doctrines. Regrettably, though, these doctrines’ analyses of race, racial identity, and the relationships between race and politics often lack sophistication, historical context, or foresight. The political status quo is treated as race-neutral, when in fact it is anything but. Specifically, the doctrines rely upon sanguine theories of democracy uncorrupted by white identity–based political calculations, while in fact such calculations, made on the part of both voters and political parties, are pervasive. In this Article, I appraise the doctrine pertaining to majority-minority voting districts, racial gerrymandering doctrine, the doctrine governing ballot access disputes, and campaign finance doctrine through the lens of white identity politics. Drawing from research in political science, sociology, and history, I argue that these doctrines are blighted by what I identify as “racial blind spots” that are inconsonant with political reality. Given the role that courts play in enunciating these doctrines, their failure to meaningfully engage with the significance of white identity politics renders their governing frameworks and remedial prescriptions inapt. The Article concludes by offering a number of suggestions, both doctrinal and legislative, for how to mitigate white identity politics

Leaping and Accelerometry: A Theoretical Approach

Accelerometry has always been a popular method of monitoring locomotor activity but its use is becoming more widespread due to the easy availability of low cost, low power sensors. However one of the major problems with interpreting accelerometer data is that rotation of the sensor alters the output and obtaining independent orientation information is currently difficult. For the specific case of leaping locomotion full orientation information is unecessary as long as an independent measure of height change is available such as can be obtained from a sensitive pressure sensor. Therefore a 4 channel logging system recording 3 accelerometry axes combined with a channel measuring pressure could be used to accurately assess leaping locomotion. This approach should also work for any locomotion where acceleration is limited to the vertical plane but in practice it may be restricted by the sensitivity and acquisition characteristics of the pressure measurement system. Ultimately it should be a useful addition to the range of measurements available for remote locomotor monitoring particularly for leaping species such as lemurs and other non-human primates

Mainstreaming New Renewable Energy Technologies

This paper outlines the benefits, obstacles and options for governments to support international markets for technology development. International markets for new energy technologies offer greater scope, thereby increasing the incentives and opportunities for technology improvements. As the market is supported by more independent governments, the confidence of technology developers and producers that future markets for their products will exist is increasing, thus enabling capital access and inducing R&D investment and exploration of improved production processes. The bigger markets also allow for international competition, thus allowing for the application of the best available technology. The government challenge to induce sufficient RD&D remains and with international markets the benefits and costs of national governments free-riding on international effort needs to be addressed. Finally, we discuss how international co-operation can be used to evolve the energy system in such a way that it can integrate new technologies at minimum cost