A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery.

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients\u27 pain experience and opioid consumption after carpal tunnel release (CTR) surgery. METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded. RESULTS: During the day of surgery and the first day following surgery, patients in the group with counseling reported significantly fewer prescribed opioid pills consumed compared with patients in the group without counseling, while experiencing no significant difference in pain level experience. In addition, patients in the group with counseling reported a significantly lower number of total pain pills consumed over the course of the study than the group without counseling. No major adverse reactions were noted in either group. CONCLUSIONS: Preoperative opioid counseling was found to result in a significant decrease in overall opioid consumption after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures. The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods. Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating. Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal. Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates

Definition of the 2005 flight deck environment

A detailed description of the functional requirements necessary to complete any normal commercial flight or to handle any plausible abnormal situation is provided. This analysis is enhanced with an examination of possible future developments and constraints in the areas of air traffic organization and flight deck technologies (including new devices and procedures) which may influence the design of 2005 flight decks. This study includes a discussion on the importance of a systematic approach to identifying and solving flight deck information management issues, and a description of how the present work can be utilized as part of this approach. While the intent of this study was to investigate issues surrounding information management in 2005-era supersonic commercial transports, this document may be applicable to any research endeavor related to future flight deck system design in either supersonic or subsonic airplane development

Islands of Effective International Adjudication: Constructing an Intellectual Property Rule of Law in the Andean Community

The Andean Community - a forty-year-old regional integration pact of small developing countries in South America - is widely viewed as a failure. In this Article, we show that the Andean Community has in fact achieved remarkable success within one part of its legal system. The Andean Tribunal of Justice (ATJ) is the world\u27s third most active international court, with over 1400 rulings issued to date. Over 90% of those rulings concern intellectual property (IP). The ATJ has helped to establish IP as a rule of law island in the Andean Community where national judges, administrative officials, and private parties actively participate in regional litigation and conform their behavior to Andean IP rules. In the vast seas surrounding this island, by contrast, Andean rules remain riddled with exceptions, under-enforced, and often circumvented by domestic actors. We explain how the ATJ helped to construct the IP rule of law island and why litigation has not spilled over to other issue areas regulated by the Andean Community. Our analysis makes four broad contributions to international law and international relations scholarship. First, we adopt and apply a broad definition of an effective rule of law, using qualitative and quantitative analysis to explain how the Andean legal system contributes to changing national decision-making in favor of compliance with Andean rules. Our definition and our explanation of the ATJ\u27s contributions to constructing an effective rule of law provide a model that can be replicated elsewhere. Second, we explain how the Andean legal system has helped domestic IP administrative agencies in the region resist pressures for stronger IP protection from national executives, the United States, and American corporations. We emphasize the importance of these agencies rather than domestic judges as key constituencies that have facilitated the emergence of an effective rule of law for IP. As a result of the agencies\u27 actions, Andean IP rules remain more closely tailored to the economic and social needs of developing counties than do the IP rules of the Community\u27s regional neighbors. Third, the reality that the ATJ is effective, but only within a single issue area, makes the Andean experience of broader theoretical interest. We offer an explanation for why Andean legal integration has not extended beyond IP. But our answer suggests avenues for additional research. We note that Andean IP rules are more specific than other areas of Andean law and that most administrative agencies in the region lack the autonomy needed to serve as compliance partners for ATJ rulings. We also find that, outside of IP, the ATJ is unwilling to issue the sort of purposive interpretations that encourages private parties to invoke Andean rules in litigation. The result is both a lack of demand for and supply of ATJ rulings. Fourth, our study of the Andean legal system provides new evidence to assess three competing theories of effective international adjudication - theories that ascribe effectiveness to the design of international legal systems, to the ability of member states to sanction international judges, and to domestic legal and political factors. We also explore the possibility that rule of law islands may be emerging in other treaty-based systems subject to the jurisdiction of international tribunals

Book reviews

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. . . und . . . Fried . . . und . . .: The Poetry of Erich Fried and the Structure of Contemporaneity

This essay looks at the poetry of Erich Fried in the context of tensions within contemporary cultural studies. Fried\u27s contemporaneity is linked to his status on the margins of various cultures, media, and ideologies—thus making both his life and his works appear as exemplary paradigms for the postmodern condition, with its various theoretical celebrations of exile, border crossing, transgression, deterritorialization, and so forth. Yet, at the same time, seemingly in contrast with his labile identity is Fried\u27s rigid Marxist political ideological core which surfaces in his political poetry. Focusing, in particular, on Fried\u27s poems directed against the Vietnam War, this essay seeks to situate the tension beteen these two positions as a deep structure already in his work

Landscapes of Ice, Snow and Wind: Alexander Kluge’s Aesthetics of Coldness

Discusses the German author and filmmaker Alexander Kluge's exploration of the theme of coldness in film and other works. The authors report on the theorist Theodor Adorno's discussion of the subject in an essay written in 1967, note that Kluge focused on coldness in works in different media created after 2010, and study his approach to the theme in the film 'Landschaften mit eis und schnee' (2010; illus.) noting his treatment of ice in the work. They assess the relationship of Kluge's film to the work of various theorists including Peter Wollen, comment on Kluge's focus on the wind in his films 'The patriot' (1979; illus.), 'Gelegenheitsarbeit einer sklavin' (1973; illus.) and other works, and report on Kluge's use of photographs of snow taken by Gerhard Richter in the book 'December' (2010; illus.) also examining the work's relationship to the films 'Landschaften mit eis und schnee' and 'Zitraffer mit schneetreiben vor meinem balkon, Elizabethstrasse 38(2010; illus.). They refer to Kluge's incorporation of footage from his films into talks given in 2010, and contrast his approach to the theme of coldness with that of Adorno

Comparison of Campylobacter coli strains isolated from pigs and humans - porcine strains a possible source of human infection?

The primary aim of this study was to detect and genotype Campylobacter strains from pigs and humans. AFLP (amplified fragment length polymorphism) analysis was used to compare different genotypes to identify the genetic diversity of Campylobacter coli (C. coli) strains. Heterogeneous patterns were detectable among the porcine and human C. coli pool. By using an optimized extraction method combined with a PCR it was possible to detect C. coli DNA in some samples of the investigated minced meat but it could not be distinguished between dead bacterial cells and viable but nonculturable cell (VBNC)-forms of C. coli strains

Altered distribution of mucosal NK cells during HIV infection.

The human gut mucosa is a major site of human immunodeficiency virus (HIV) infection and infection-associated pathogenesis. Increasing evidence shows that natural killer (NK) cells have an important role in control of HIV infection, but the mechanism(s) by which they mediate antiviral activity in the gut is unclear. Here, we show that two distinct subsets of NK cells exist in the gut, one localized to intraepithelial spaces (intraepithelial lymphocytes, IELs) and the other to the lamina propria (LP). The frequency of both subsets of NK cells was reduced in chronic infection, whereas IEL NK cells remained stable in spontaneous controllers with protective killer immunoglobulin-like receptor/human leukocyte antigen genotypes. Both IEL and LP NK cells were significantly expanded in immunological non-responsive patients, who incompletely recovered CD4+ T cells on highly active antiretroviral therapy (HAART). These data suggest that both IEL and LP NK cells may expand in the gut in an effort to compensate for compromised CD4+ T-cell recovery, but that only IEL NK cells may be involved in providing durable control of HIV in the gut