A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy

BACKGROUND: Perioperative neuropathic pain is under-recognized and often undertreated. Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the perioperative period with the potential to reduce the risk of chronic pain. DATABASES AND DATA TREATMENT: A systematic review of the evidence for perioperative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy. RESULTS: Thirty-two randomized controlled trials met the inclusion criteria. Gabapentinoids reduced pain after mastectomy, but a single dose was ineffective for thoracotomy patients who had an epidural. Gabapentinoids were ineffective for vascular amputees with pre-existing chronic pain. Venlafaxine was associated with less chronic pain after mastectomy. Intravenous and topical lidocaine and perioperative EMLA (eutectic mixture of local anaesthetic) cream reduced the incidence of chronic pain after mastectomy, whereas local anaesthetic infiltration appeared ineffective. The majority of the trials investigating regional analgesia found it to be beneficial for chronic symptoms. Ketamine and intercostal cryoanalgesia offered no reduction in chronic pain. Total intravenous anaesthesia (TIVA) reduced the incidence of post-thoracotomy pain in one study, whereas high-dose remifentanil exacerbated chronic pain in another. CONCLUSIONS: Appropriate dose regimes of gabapentinoids, antidepressants, local anaesthetics and regional anaesthesia may potentially reduce the severity of both acute and chronic pain for patients. Ketamine was not effective at reducing chronic pain. Intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain. TIVA may be beneficial but the effects of opioids are unclear

Temperature and gravity of the pulsating extreme helium star LSS 3184 (BX Cir) through its pulsation cycle

We report the analysis of optical spectra of the extreme helium star LSS 3184 (BX Cir) to determine its effective temperature and gravity throughout its pulsation cycle. The spectra were also used to measure its chemical abundances. We report rest gravity, log g = 3.38 +/- 0.02, and a chemical abundance mixture consistent with those reported earlier in a study using an optical spectrum with lower spectral resolution and a lower signal to noise ratio. Our analysis decreases the upper limit for the H abundance to H < 6.0 (mass fraction < 7.1 x 10^-7). Our gravity corresponds to stellar mass M = 0.47 +/- 0.03 M_sun. We find that the effective log g varies through the pulsation cycle with an amplitude of 0.28 dex. The effective gravity is smaller than the rest gravity except when the star is very near its minimum radius. The change in effective gravity is primarily caused by acceleration of the stellar surface. Based on the optical spectra, we find the temperature varies with an amplitude of 3450 K. We find a time averaged mean temperature, 23390 +/- 90 K, consistent with that found in the earlier optical spectrum study. The mean temperature is 1750 K hotter than that found using combined ultraviolet spectra and V and R photometry and the variation amplitude is larger. This discrepancy is similar to that found for the extreme helium star V652 Her.Comment: 7 pages, 6 figures, LaTeX, to be published in A&

Using Voice Recognition Software to improve communicative writing and social participation in an individual with severe acquired dysgraphia: an experimental single case therapy study

Background Two previous single-case studies have reported that voice recognition software (VRS) can be a powerful tool for circumventing impaired writing in aphasia (Bruce et al, 2003; Estes & Bloom, 2011). However, these studies report mixed results regarding transfer of skills to functional tasks, such as emailing. Method A single-case therapy study was conducted with “Stephen”, a 63 -year old man with fluent aphasia and severe acquired dysgraphia and dyslexia limiting his social participation and ability to return to work. Treatment consisted of 16 one-hour sessions. Stephen was trained to use Dragon NaturallySpeakingRTM VRS to assist writing and Read+WriteGoldRTM text-to-speech software to assist reading, and to develop computer skills required to use email. Outcome measures evaluated writing efficiency and communicative effectiveness, the functional impact of the intervention, and changes in participation. Results Training produced significant gains in the efficiency and communicative effectiveness of Stephen’s writing, despite his underlying writing impairment remaining unchanged. Gains generalised to everyday functional communication, leading to increased social participation with Stephen undertaking a wider range of social activities and increasing his social network following treatment. Gains were maintained at follow-up assessment. Discussion Results indicate that a relatively short training period with assistive technologies achieved extensive generalisation to independent, functional communicative writing. Indeed, for this case, VRS training may have exceeded the degree of improvement in functional text writing that could have been achieved through impairment therapy, since gains were not limited to treated vocabulary. Some challenges were encountered in training Stephen to use VRS but, through adaptations to the training process, were largely overcome. Importantly, regaining independent writing skills resulted in profound and life-changing improvements to social participation. This may have resulted in Stephen reconnecting with important aspects of his pre-stroke identity, and improving his self-esteem. Conclusion This case adds to a small evidence base indicating that training in the use of VRS, in combination with text-to-speech software, may be an effective way to address writing impairments in chronic aphasia for individuals with relatively well-preserved spoken output. Not only can these technologies improve the efficiency and communicative effectiveness of writing, they can also lead to significant gains in functional communication and social participation. Further research is needed trialing this approach with a larger group of people with aphasia

NIMBUS-5 sounder data processing system. Part 2: Results

The Nimbus-5 spacecraft carries infrared and microwave radiometers for sensing the temperature distribution of the atmosphere. Methods developed for obtaining temperature profiles from the combined set of infrared and microwave radiation measurements are described. Algorithms used to determine (a) vertical temperature and water vapor profiles, (b) cloud height, fractional coverage, and liquid water content, (c) surface temperature, and (d) total outgoing longwave radiation flux are described. Various meteorological results obtained from the application of the Nimbus-5 sounding data processing system during 1973 and 1974 are presented

Variability in the extreme helium star LSS 5121

We report a photometric and spectroscopic study of the hot extreme helium star LSS 5121. We found photometric variability, but no period was evident in its periodogram. This is consistent with the previous proposal, based on spectral line variations, that LSS 5121 is a non-radial pulsator similar to other hot extreme helium stars.Comment: 5 pages, 6 figure

The academic backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

Background: Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades. Methods: Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register. Results: Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies. Conclusions: The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection

Radial velocity variations of the pulsating subdwarf B star PG 1605+072

We present an analysis of high-speed spectroscopy of the pulsating subdwarf B star PG 1605+072. Periodic radial motions are detected at frequencies similar to those reported for photometric variations in the star, with amplitudes of up to 6 km/s. Differences between relative strengths for given frequency peaks for our velocity data and previously measured photometry are probably a result of shifting of power between modes over time. Small differences in the detected frequencies may also indicate mode-shifting. We report the detection of line-shape variations using the moments of the cross correlation function profiles. It may be possible to use the moments to identify the star's pulsation modes.Comment: 5 pages, 6 figure

Therapy for Auditory Processing Impairment in Aphasia: An evaluation of two approaches

Purpose: This study evaluated two forms of discrimination therapy for auditory processing impairment in aphasia. It aimed to determine whether therapy can improve speech perception and/or help participants use semantic information to compensate for their impairment. Changes in listening were also explored by recording the level of facilitation needed during therapy tasks. Finally the study examined the effect of therapy on an everyday listening activity: a telephone message task. Method: The study employed a repeated measures design. Eight participants received 12 sessions each of phonological and semantic-phonological therapy. Both programmes used minimal pair judgement tasks, but the latter embedded such tasks within a meaningful context, so encouraged the strategic use of semantic information (semantic bootstrapping). Experimental measures of auditory discrimination and comprehension were administered twice before therapy, once after each programme, and again six weeks later. The telephone message task was also administered at each time point. Test data were subjected to both group and individual analyses. Records of progress during therapy (i.e changes in support needed to carry out therapy tasks) were completed during treatment and analysed across the group. Results: Group analyses showed no significant changes in tests of word and nonword discrimination as a result of therapy. One comprehension task improved following therapy, but two did not. There was also no indication that therapy improved the discrimination of treated words, as assessed by a priming task. The facilitation scores indicated that participants needed less support during tasks as therapy progressed, possibly as a result of improved listening. There was a significant effect of time on the telephone message task. Across all tasks there were few individual gains. Conclusions: The results offer little evidence that therapy improved participants’ discrimination or semantic bootstrapping skills. Some changes in listening may have occurred, as indicated by the facilitation scores. Reasons for the null findings are discussed