Paravertebral Block for Post-Operative Analgesia after Breast Cancer Surgery, Effects of Adding Morphine: Double Blind, Randomised Clinical Trial

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Introduction: Thoracic paravertebral block (PVB) block is frequently used in breast cancer surgery for postoperative pain management. Adding opioids to local anaesthetics has been shown to have beneficial effects during epidural analgesia. Our hypothesis was that adding morphine to bupivacaine for PVB would improve analgesia provided by this procedure. Methods: 60 patients (25 - 75 years) undergoing elective surgery for breast cancer were randomly assigned to one of two groups. Both groups received a single injection thoracic paravertebral block; group BAM with 20 ml 0.5% bupivacaine, epinephrine and morphine while group BA received identical block except morphine was given subcutaneously. All patients had general anaesthesia. Results: Severity of pain and nausea was low in both groups. Pain scores remained below 20/100 after the first 2 hours throughout the 72 hours of the study. There was no significant difference between the groups in pain scores, consumption of additional morphine or nausea scores. Shoulder mobility was also very good in both groups. Conclusion: Thoracic paravertebral block with bupivacaine and epinephrine was associated with good postoperative analgesic effects and low incidence of nausea and vomiting. The addition of morphine to the local anaesthetic solution in paravertebral block did not have any additional analgesic effects

Reconciling biodiversity conservation and agricultural expansion in the sub-arctic environment of Iceland

Intensified agricultural practices have driven biodiversity loss throughout the world and, although many actions aimed at halting and reversing these declines have been developed, their effectiveness depends greatly on the willingness of stakeholders to take part in conservation management. Knowledge of the willingness and capacity of landowners to engage with conservation can therefore be key to designing successful management strategies in agricultural land. In Iceland, agriculture is currently at relatively low intensity but is very likely to expand in the near future. At the same time, Iceland supports internationally important breeding populations of many ground-nesting birds which could be seriously impacted by further expansion of agricultural activities. To understand the views of Icelandic farmers towards bird conservation, given the current potential for agricultural expansion, 62 farms across Iceland were visited and farmers were interviewed, using a structured questionnaire survey in which respondents indicated a series of future actions. Most farmers intend to increase the area of cultivated land in the near future and, despite considering having rich birdlife on their land to be very important, most also report they are unlikely to specifically consider bird conservation in their management, even if financial compensation were available. However, as no agri-environment schemes are currently in place in Iceland, this concept is highly unfamiliar to Icelandic farmers. Nearly all respondents were unwilling, and thought it would be impossible, to delay harvest, but many were willing to consider sparing important patches of land and/or maintaining existing pools within fields (a key habitat feature for breeding waders). Farmers’ views on the importance of having rich birdlife on their land and their willingness to participate in bird conservation provide a potential platform for the co-design of conservation management with landowners before further substantial changes in the extent of agriculture take place in this sub-arctic landscape

Ecosystem recharge by volcanic dust drives broad-scale variation in bird abundance

Across the globe, deserts and volcanic eruptions produce large volumes of atmospheric dust, and the amount of dust is predicted to increase with global warming. The effects of long-distance airborne dust inputs on ecosystem productivity are potentially far-reaching but have primarily been measured in soil and plants. Airborne dust could also drive distribution and abundance at higher trophic levels, but opportunities to explore these relationships are rare. Here we use Iceland's steep dust deposition gradients to assess the influence of dust on the distribution and abundance of internationally important ground-nesting bird populations. Surveys of the abundance of breeding birds at 729 locations throughout lowland Iceland were used to explore the influence of dust deposition on bird abundance in agricultural, dry, and wet habitats. Dust deposition had a strong positive effect on bird abundance across Iceland in dry and wet habitats, but not in agricultural land where nutrient levels are managed. The abundance of breeding waders, the dominant group of terrestrial birds in Iceland, tripled on average between the lowest and highest dust deposition classes in both wet and dry habitats. The deposition and redistribution of volcanic materials can have powerful impacts in terrestrial ecosystems and can be a major driver of the abundance of higher trophic-level organisms at broad spatial scales. The impacts of volcanic ash deposition during eruptions and subsequent redistribution of unstable volcanic materials are strong enough to override effects of underlying variation in organic matter and clay content on ecosystem fertility. Global rates of atmospheric dust deposition are likely to increase with increasing desertification and glacier retreat, and this study demonstrates that the effects on ecosystems are likely to be far-reaching, both in terms of spatial scales and ecosystem components

The interindividual variation in femoral neck width is associated with the acquisition of predictable sets of morphological and tissue‐quality traits and differential bone loss patterns

A better understanding of femoral neck structure and age‐related bone loss will benefit research aimed at reducing fracture risk. We used the natural variation in robustness (bone width relative to length) to analyze how adaptive processes covary traits in association with robustness, and whether the variation in robustness affects age‐related bone loss patterns. Femoral necks from 49 female cadavers (29–93 years of age) were evaluated for morphological and tissue‐level traits using radiography, peripheral quantitative computed tomography, micro–computed tomography, and ash‐content analysis. Femoral neck robustness was normally distributed and varied widely with a coefficient of variation of 14.9%. Age‐adjusted partial regression analysis revealed significant negative correlations ( p   0.2). The results indicated that slender femora were constructed with a different set of traits compared to robust femora, and that the natural variation in robustness was a determinant of age‐related bone loss patterns. Clinical diagnoses and treatments may benefit from a better understanding of these robustness‐specific structural and aging patterns. © 2012 American Society for Bone and Mineral Research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92024/1/1614_ftp.pd

High expression of ZNF703 independent of amplification indicates worse prognosis in patients with luminal B breast cancer

Peer reviewe

Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: The osteoporotic fractures in men (MrOS) study

This prospective case-cohort study aimed to map the distribution of bone density in the proximal femur and examine its association with hip fracture. We analyzed baseline quantitative computed tomography (QCT) scans in 250 men aged 65 years or older, which comprised a randomly-selected subcohort of 210 men and 40 cases of first hip fracture during a mean follow-up period of 5.5 years. We quantified cortical, trabecular, and integral volumetric bone mineral density (vBMD), and cortical thickness (CtTh) in four quadrants of cross-sections along the length of the femoral neck (FN), intertrochanter (IT), and trochanter (TR). In most quadrants, vBMDs and CtTh were significantly (p  0.05) better than TH aBMD. With an area under the receiver operating characteristic curve (AUC) of 0.901 (95% CI, 0.852–0.950), the regression model combining TH aBMD, age, and trabecular vBMD predicted hip fracture significantly (p < 0.05) better than TH aBMD alone or TH aBMD plus age. These findings confirm that both cortical and trabecular bone contribute to hip fracture risk and highlight trabecular vBMD at the FN and TR as an independent risk factor

What's love got to do with it? Love-life gossip and migration intentions in rural Iceland

Curiosity and gossip often underline human activities and social behavior. Gossip can work as an instrument of power, controlling people's actions but can it actively play a role in migration intentions? Migration studies often focus on structural and economic factors that influence people's decisions to relocate, but socio-cultural factors such as gossip are not often included. Gossip is considered a fixed, given characteristic of small close-knit communities. Those communities often face the fact that fewer women decide upon residency in these locations. This research reveals the influence of personal gossip about love-life on out-migration intentions in small communities in Iceland, particularly for women. The research uses quantitative data from 56 villages in rural Iceland, collected as an online survey, examining migration and migration intentions. This paper examines if gossip in small close-knit rural communities can affect migration intentions and if this is particularly an issue for women. Our data show, that this is indeed the case. That is, the more gossip there is about people's love-life, the more likely they are to have migration intentions. However, we do not find a significant gender difference in migration intentions in regards to this intimate type of gossip

Cortical bone assessed with clinical computed tomography at the proximal femur.

Hip fractures are the most serious of all fragility fractures in older people of both sexes. Trips, stumbles, and falls result in fractures of the femoral neck or trochanter, and the incidence of these two common fractures is increasing worldwide as populations age. Although clinical risk factors and chance are important in causation, the ability of a femur to resist fracture also depends on the size and spatial distribution of the bone, its intrinsic material properties, and the loads applied. Over the past two decades, clinical quantitative computed tomography (QCT) studies of living volunteers have provided insight into how the femur changes with advancing age to leave older men and women at increased risk of hip fractures. In this review, we focus on patterns of cortical bone loss associated with hip fracture, age-related changes in cortical bone, and the effects of drugs used to treat osteoporosis. There are several methodologies available to measure cortical bone in vivo using QCT. Most techniques quantify bone density (g/cm(3)), mass (g), and thickness (mm) in selected, predefined or “traditional” regions of interest such as the “femoral neck” or “total hip” region. A recent alternative approach termed “computational anatomy,” uses parametric methods to identify systematic differences, before displaying statistically significant regions as color-scaled maps of density, mass, or thickness on or within a representative femur model. This review will highlight discoveries made using both traditional and computational anatomy methods, focusing on cortical bone of the proximal femur.This work was supported by Cambridge NIHR Biomedical Research Centre (Metabolism, Endocrinology, Bone and Biomaterials Theme), Arthritis Research UK (a Research Progression award to KESP). TDT is a Wellcome Trust Clinical Research Fellow. The femurs shown in Fig. 2 are courtesy of the Melbourne Femur Collection, Chairman Professor John Clement (Melbourne Dental School).This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/jbmr.219

En kunnskapsbasert fagprosedyre for nødthorakotomi i traumemottak for operasjonssykepleiere

Master's thesis in Nursing scienceBakgrunn: Det Nasjonale traumeregisteret i Norge registrerte 7944 traumer i 2017. Nødthorakotomi i traumemottak er et forsøk på livreddende behandling på utblødde pasienter som ikke har effekt av intravenøs væskeresuscitering. Operasjonssykepleier skal ha kunnskap om forberedelser og kirurgisk assistanse ved mottakelse av traume. Effektivt og godt forberedt traumeteam kan bidra til å redde liv. Hensikt: Hensikten med masteroppgaven og kvalitetsforbedringsprosjektet er å utvikle en kunnskapsbasert fagprosedyre for operasjonssykepleiere, der målet er å standardisere forberedelsen og assistansen ved nødthorakotomi i traumemottak. Metode: Helsebibliotekets metode og minstekrav, som bygger på AGREE II, er benyttet i utarbeidelsen av fagprosedyren. Litteratursøket er gjennomført i samarbeid med bibliotekar for å kvalitetssikre søket. Cinahl, PubMed, UpToDate, Epistemonikos, Medline og The Cochrane Library ble anvendt i søket etter relevant litteratur. De inkluderte artiklene er vurdert med helsebibliotekets sjekklister, der retningslinjene i tillegg er vurdert med AGREE II rating scale. Resultat: Det systematiske litteratursøket resulterte i to retningslinjer, tre systematiske oversikter og to oversiktsartikler som dannet det forskningsbaserte kunnskapsgrunnlaget for fagprosedyren. Anbefalingene i fagprosedyren omhandler operasjonssykepleierens ansvar til forberedelser og assistanse ved nødthorakotomi i traumemottak. Prosjektgruppen har bistått med erfaringsbasert kunnskap ved utarbeidelse av anbefalingene, samt algoritmen og den visuelle støtten av assistansebordet. Konklusjon: Operasjonssykepleiere har en viktig rolle ved nødthorakotomi i traumemottak, hvor de er ansvarlige for at forberedelser og assistanse gjennomføres på en trygg måte. Vår kunnskapsbaserte fagprosedyre bidrar til kvalitetsforbedring for å ivareta pasientsikkerheten til pasienter som gjennomgår nødthorakotomi i traumemottak