Epidural opioid analgesia after caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine

The quality of analgesia, patient satisfaction and incidence of side effects following a single bolus of epidural morphine were compared with patient-controlled epidural analgesia (PCEA) with meperidine during the first 24 hr after elective Caesarean section. Seventy-five women were randomly assigned to three equal groups. Group I received 30 mg epidural meperidine after delivery and PCEA with meperidine; Group 2 received 3 mg epidural morphine after delivery and PCEA with saline in a double-blind fashion. Group 3 received 3 mg epidural morphine after delivery without saline PCEA. Visual analogue pain scores (VAS) were higher with PCEA meperidine from 8-16 hr post-operatively (P < 0.05) than in both epidural morphine groups. Two patients in Group 1 and one in Group 3 required supplemental parental analgesia. The incidence of nausea was 16% in Group 1, compared with 52% in Group 2 and 56% in Group 3 (P < 0.01). Pruritus occurred in 24% of Group 1 patients, 84% of patients in Group 2 and 68% of patients in Group 3 (P < 0.001). Forty-six percent of patients in Group 1 were very satisfied with pain management, compared with 77% in Group 2 and 79% in Group 3. Nurse workload was higher in the PCEA study groups than in Group 3 (P < 0.05). A single bolus of epidural morphine provides superior analgesia and satisfaction at low cost, but with a higher incidence of nausea and pruritus than PCEA with meperidine.     

Edge-to-edge interfaces in Ti?Al modeled with the embedded atom method

The atomistic structure and energies of high-index interphase boundaries are explored using a combination of molecular statics and dynamics simulations with embedded atom potentials. We investigate planar boundaries between the α₂ and γ phases in the Ti−Al system. The class of boundaries considered has a high-index boundary orientation; the orientation relationship between the α₂ and γ phases also is high index, and a set of planes from each phase meet edge to edge at the boundary plane. For the particular case of a boundary that is commensurate in one direction and coincides with a moiré plane given by the so-called “Δg” diffraction condition, the boundary is not structurally singular, but it is energetically stable and does not appear to dissociate into other low-energy configurations. Misfit compensating defects are not observed; misfit in directions other than the commensurate one appears to be distributed uniformly. The boundary energy is evaluated as a function of the orientation of the boundary plane, and the edge-to-edge (moiré) boundary is found to lie in an energy cusp. This article is based on a presentation made in the “Hume-Rothery Symposium on Structure and Diffusional Growth Mechanisms of Irrational Interphase Boundaries,” which occurred during the TMS Winter meeting, March 15–17, 2004, in Charlotte, NC, under the auspices of the TMS Alloy Phases Committee and the co-sponsorship of the TMS-ASM Phase Transformations Committee.     

Effect of sampling density on the measurement of stream condition indicators in two lowland Australian streams

There is widespread application of indicators to the assessment of environmental condition of streams. These indicators are intended for use by managers in making various comparative and absolute assessments and often have a role in resource allocation and performance assessment. Therefore, the problem of formally defining confidence in the results is important but difficult because the sampling strategies used are commonly based on a compromise between the requirements of statistical rigour and the pragmatic issues of access and resources. It is rare to see this compromise explicitly considered and consequently there is seldom quantification of the uncertainty that could affect the confidence a manager has in an indicator. In this paper, we present a method for quantitatively assessing the tradeoffs between sampling density and uncertainty in meeting various monitoring objectives. Assessments using judgement‐based representative reaches are shown to be unreliable; instead a sampling approach is recommended based on the random selection of measuring sites. A detailed dataset was collected along two streams in Victoria, Australia, and the effect of sampling density was assessed by subsampling from this dataset with precision related to the number of sites assessed per reach length and the intensity of the sampling at each site. The sampling scheme to achieve a given precision is shown to depend on the monitoring objective. In particular, three objectives were considered: (1) making a baseline assessment of current condition; (2) change detection; and (3) detection of a critical threshold in condition. Change detection is shown to be more demanding than assessing baseline condition with additional sampling effort required to achieve the same precision. Sampling to detect a critical threshold depends on nominating acceptable values of Type I and II error and the size of the effect to be detected. Copyright © 2006 John Wiley & Sons, Ltd.     

Moral value transfer from regulatory fit: What feels right is right and what feels wrong is wrong.

People experience regulatory fit (E. T. Higgins, 2000) when the strategic manner of their goal pursuit suits their regulatory orientation, and this regulatory fit feels right. Fit violation feels wrong. Four studies tested the proposal that experiences of fit can transfer to moral evaluations. The authors examined transfer of feeling wrong from fit violation by having participants in a promotion or prevention focus recall transgressions of commission or omission (Studies 1 and 2). Both studies found that when the type of transgression was a fit violation, participants expressed more guilt. Studies 3 and 4 examined transfer of feeling right from regulatory fit. Participants evaluated conflict resolutions (Study 3) and public policies (Study 4) as more right when the means pursued had fit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metric-based reasoning about pseudocode design in the partial metrics system

The goal of the PMS project is to produce an environment in which the intelligent online assessment of the design for large-scale ADA programming projects is provided. The focus is on the representation of knowledge about the design process for an individual module. Changes in pseudocode complexity are measured in terms of partial metrics. These metrics can take the designers inferences about the pseudocode program structure into account when assessing module complexity. Next, a model of the stepwise refinement process is given which demonstrates how pseudocode elaboration decisions can be modelled in partial metric terms. Finally, the decisions associated with each refinement step for 17 example refinements taken from the computer science literature are described using partial metrics.     

The human homologue of yeast CRM1 is in a dynamic subcomplex with CAN/Nup214 and a novel nuclear pore component Nup88

The oncogenic nucleoporin CAN/Nup214 is essential in vertebrate cells. Its depletion results in defective nuclear protein import, inhibition of messenger RNA export and cell cycle arrest. We recently found that CAN associates with proteins of 88 and 112 kDa, which we have now cloned and characterized. The 88 kDa protein is a novel nuclear pore complex (NPC) component, which we have named Nup88. Depletion of CAN from the NPC results in concomitant loss of Nup88, indicating that the localization of Nup88 to the NPC is dependent on CAN binding. The 112 kDa protein is the human homologue of yeast CRM1, a protein known to be required for maintenance of correct chromosome structure. This human CRM1 (hCRM1) localized to the NPC as well as to the nucleoplasm. Nuclear overexpression of the FG-repeat region of CAN, containing its hCRM1-interaction domain, resulted in depletion of hCRM1 from the NPC. In CAN-/- mouse embryos lacking CAN, hCRM1 remained in the nuclear envelope, suggesting that this protein can also bind to other repeat-containing nucleoporins. Lastly, hCRM1 shares a domain of significant homology with importin-beta, a cytoplasmic transport factor that interacts with nucleoporin repeat regions. We propose that hCRM1 is a soluble nuclear transport factor that interacts with the NPC.     

Optimisation of antibiotic therapy in cystic fibrosis patients. Pharmacokinetic considerations

Antibiotic therapy plays a central role in the medical management of patients with cystic fibrosis. While totally convincing efficacy data are lacking, antibiotics probably have a pronounced beneficial effect on both morbidity and mortality. Much has been learned in the past 20 years about antibiotic use in this population. At the same time, new antimicrobial agents with the potential to treat this condition have become available for use. The pharmacokinetics of a number of antibiotic classes, including beta-lactams, aminoglycosides and quinolones, are altered in this patient population. Increased total body clearance is a common occurrence but is not always changed enough to warrant altered dosages. Nonetheless, in light of altered pharmacokinetics in the cystic fibrosis population, appropriate dosage and monitoring parameters for a number of antibiotics have been determined.