Relief In Order Research Articles

Postoperative Epidural Fibrosis: Challenges and Opportunities - A Review.

Postoperative epidural fibrosis (EF) is still a major limitation to the success of spine surgery. Fibrotic adhesions in the epidural space, initiated via local trauma and inflammation, can induce difficult-to-treat pain and constitute the main cause of failed back surgery syndrome, which not uncommonly requires operative revision. Manifold agents and methods have been tested for EF relief in order to mitigate this longstanding health burden and its socioeconomic consequences. Although several promising strategies could be identified, few have thus far overcome the high translational hurdle, and there has been little change in standard clinical practice. Nonetheless, notable research progress in the field has put new exciting avenues on the horizon. In this review, we outline the etiology and pathogenesis of EF, portray its clinical and surgical presentation, and critically appraise current efforts and novel approaches toward enhanced prevention and treatment.

The role of landiolol in the management of atrial tachyarrhythmias in patients with acute heart failure and cardiogenic shock: case reports and review of literature.

Atrial tachyarrhythmias and worsening heart failure frequently coexist and potentially progress to a life threatening condition. Therapeutic approach requires simultaneous management of rapid ventricular response and heart failure symptom relief in order to improve haemodynamic stability and cardiac function. Landiolol is an ultra-short-acting b-adrenergic receptor blocker with high b1 selectivity incorporated in 2020 European Society of Cardiology guidelines for the management of atrial fibrillation. We provide a report of two cases with atrial fibrillation treated with landiolol in the acute setting of pulmonary oedema and cardiogenic shock, respectively. Additionally, we searched the international database PUBMED (MEDLINE, PubMed Central) to retrieve scientific evidence regarding its implementation in the treatment of atrial tachyarrhythmias in patients with cardiac dysfunction. Recent studies support the use of landiolol in patients with acute heart failure and atrial tachyarrhythmias. Compared to digoxin, landiolol proved to be more effective in controlling heart rate, with minimal adverse effects. Moreover, landiolol may be helpful in the conversion of atrial tachyarrhythmia to sinus rhythm. A more potent effect has been reported in patients with heart failure with preserved or mildly reduced ejection fraction, small left ventricular volume and high blood pressure. Likewise, administration of low doses of landiolol in patients with cardiogenic shock and atrial tachyarrhythmias reduced heart rate and pulmonary capillary wedge pressure and improved cardiac contractility without reducing blood pressure. Landiolol seems to be an attractive alternative in the acute management of patients with atrial tachyarrhythmias and cardiac dysfunction, though further clinical trials are needed to establish its role.

Since the mid-1980s: a value shift in work in Israel - from labor to employment

ABSTRACT During the first two decades of statehood, Israeli labor policy advocated for full employment by creating new workplaces or work relief in order to absorb the mass waves of immigration. The dominant ideology was that of work ethos – work was perceived as a human and social value; therefore, Israelis believed that money should be paid for work and not for unemployment. In the beginning of the 1960s, the government related to labor as an economic instrument that was supposed to serve the meta-economic goal of economic independence. The political and social relations that existed between 1967 and 1985 were based on human capital and material reward. This was a liminal period. Since 1985, the government has led a revolution that transformed work into employment. This converted the workers into employees who serve economic and business ends. Labor became employment. Led by the Israeli government, this transformation ran counter to workers’ attitudes that preferred job security and collective stability. The fundamental change was dictated from above and was not a consensual shift.

Compensating Landowners? The State's (Limited) Duty toward Landowners in Delayed Eviction Matters

The unlawful occupation of private land creates a tension between the interests of the unlawful occupiers to avoid homelessness and the landowner to regain control of its property. To balance the interests and rights of the occupiers and the landowners, courts have relied on the municipality, due to its constitutional housing duty, to provide the unlawful occupiers with alternative accommodation. The provision of alternative accommodation prevents homelessness, while at the same time allowing the landowner to regain control of its property.
 In response to demands by unlawful occupiers that they provide alternative accommodation, municipalities have either failed to cooperate or argued that they are unable to accommodate the unlawful occupiers immediately due to resource constraints. This has led to delays in eviction matters to the detriment of landowners. Only in one delayed eviction matter did the Constitutional Court order relief for the landowner. It ordered the municipality to pay constitutional damages to the landowner. After this order, scholars have advocated for similar relief to be granted in other delayed eviction matters. This article aims to add to that debate, by determining under what circumstances an award of constitutional damages in such matters would be appropriate, just and equitable, as is required of a constitutional remedy.

Calling for Openness to the Study of Cannabis Use in Chronic Pelvic Pain.

Chronic pelvic pain affects women across all demographics. Its management is complex and requires a multimodal approach. Cannabis has been legal for medical purposes for many years; however, its pharmacokinetics are just beginning to be understood, as are its analgesic effects and other benefits, such as improved sleep quality and reduced nausea and vomiting. Given the recent Canada-wide legalization of cannabis for non-medical use, patients may be more willing to disclose cannabis use and use it for pain management. Given the complexity of chronic pain management, physicians must be open to cannabis as an analgesic option. Cannabis use may decrease the need for opioids, a phenomenon that could reduce opioid dependency. Now is the ideal time to study patients' use of and perspectives on cannabis for pain relief in order to establish its effectiveness and safety. Cannabis shows potential to be a key player in a multimodal approach to chronic pelvic pain.

Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree.

Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to standardize clinical decision making and maximize the success of oral surgical treatment of MRONJ. Methods: Different surgical approaches were categorized taking into consideration two variables (a) hard tissue management (defined as debridement, saucerization or marginal resective surgery of maxillary necrotic bone) and (b) soft tissue management (defined as type of flap design and related modality of wound-healing). Results: For the retrospective cohort study, 103 MRONJ patients were enrolled and a total of 128 surgical procedures were performed. The role of radical-intended surgery using local flaps in MRONJ treatment was investigated, as well as palliative treatments. All stage I–II patients completely healed when a combination of radical necrotic bone surgery associated with a first intention healing of soft tissues was obtained. In stage III, when a patient was not eligible for maxillo-facial surgery, the use of palliative surgical strategies was effective in symptom relief in order to maintain a better quality of life for the duration of the patient’s life. Conclusions: Oral surgery with radical intent associated with a flap design able to ensure first intention healing might represent a valid option for the majority of MRONJ patients. The designed decision tree allows clinicians to assess individual surgical approaches for MRONJ treatment in accordance with patient-centered outcomes and surgical skills.

Organisation of Soils along the Sides of Interfluves in the Western Highlands of Cameroon: Case Study of an Andosolic Toposequence on Trachyte in the Upper Part of the Southern Limb of Bambouto Mountains

The acquisition of knowledge on soils tells how to use them sustainably. So, the organization of soils along the sides of interfluves in the western highlands of Cameroon was put into relief in order to understand their genesis, organization, and evolution. Field work and lab analysis helped to reach the focuses. These soils are thin, highly differentiated, with many local specificities. Their organization and their thickness vary from up to downhill. Vertically, they include: An isalteritic horizon; a yellow vague polyhedral horizon; a red distinct polyhedral horizon; a discontinuous breastplate with two facies; a porous vague crumby dark reddish brown horizon; and a strongly dark grey, porous, thixotropic and crumby superficial horizon. The pedon/alterite ratio is about 2/1, and the hardened level/alterite ratio is 1/4. The alteritic level represents about 1/3 of the whole soil profile. Microscopically, these soils lack plasmic separations. Plasmas are respectively isotic in the dark reddish brown and strongly dark grey horizons, clayey asepic in the yellow and red polyhedral horizons, cristic in the isalteritic horizon, cristic and locally isotic in the discontinuous breastplate. Gibbsite, halloysite, kaolinite and allophane are the main minerals; goethite, quartz, hematite and rutile are also present. Geochemically, aluminum is the main chemical component in the deepest horizons, while in those at the top of the soil profile, silicon and aluminum has quite similar concentrations. Others specificities include their low bulk density (0.6 to 0.9 gcm-3), the abundance of clayey particles at the bottom of the soil profile, sand and silt at its summit. Ferrallitic and andosolic characteristics coexist in the studied soils. This ambivalence makes them to be simply «andic ferallitic, desaturated, humic and strongly rejuvenated soils».

(125) When Patients Take Charge of Opioids: Self-Management and Safety of Prescribed Opioids for Cancer Pain in the Context of Opioid Crisis

Among insured adults, patients with cancer have more pharmacy claims and claims for higher doses of opioids. Patients with cancer also remain exempt from most state legislation and policy initiatives on prescribing opioids, necessitating a critical understanding of opioid management and risks among this group. This multi-method study investigated pain and opioid self-management practices reported by adult cancer patients recruited from an outpatient oncology clinic of an NCI-designated cancer center (n=65; mean age 56.3, SD=12.3; pain 6.0, SD=2.8; >50% with metastatic disease; IRB approval, University of Pennsylvania). Using Freelisting analysis (Smith's salience index, ANTHROPAC), “pain relief” and “addiction” were the most salient concerns identified by the participants. In the qualitative interviews (n=32, ATLAS ti. 8.0), taking charge of the prescribed opioids emerged as a major theme. Patients described opioid self-management practices including using long-acting/extended-release opioids on an as-needed basis; increasing duration between opioid doses until pain is “pretty bad” or “unbearable”; reducing prescribed opioid dose by cutting pills into half or one-quarter; self-tapering of opioids; outsourcing opioid management decisions to a family member to minimize potential risk for addiction; combining acetaminophen and ibuprofen for pain relief in order to avoid prescription opioids; and use of licit and illicit marijuana to avoid having to go to prescribed opioids, which were considered “harder pills”. Many patients described knowing someone affected by opioid crisis, thought clinicians are quick to prescribe opioids without simultaneously providing alternatives; many preferred non-opioid treatments for pain but more commonly faced a variety of access barriers. While the recent HHS Pain Management Taskforce has identified self-management as one of the best practices for improving pain, function, and safety of prescribed opioids4, our findings point to potentially unsafe opioid self-management practices among cancer outpatients needing urgent attention to improve education and access to effective alternative treatments. Funding: American Cancer Society#128779-PEP-15-186-01.

A Probabilistic Approach to Deploying Disaster Response Network

Disasters, in most cases, cause the breakdown of important structures, such as communication and Internet connection. This is concerning because victims need a way to communicate, either to contact family and loved ones for emotional support or those responsible for disaster relief in order to coordinate rescue and safety measures. Because these scenarios are characterized by a lack of infrastructure, one attractive solution is to bring in mobile communication units to provide connection as part of disaster relief. This is the basis behind moveable and deployable resource unit (MDRU) based wireless mesh networks (WMN), where the MDRU is a communication equipment, usually mounted on a vehicle, that is deployed into a disaster area to establish a WMN (i.e., a mostly static, highly interconnected network) with an Internet connection. Here, the MDRU is the one responsible for connecting victims to exterior networks. However, MDRU based WMNs are composed of different hierarchical levels, such as routers and gateways, as well as the MDRU and users themselves. Despite this, existing literature model it as a flat network. In this paper, we propose a hierarchical model of the MDRU based WMN, which is more realistic than conventional research. Additionally, our model exposes an interlevel tradeoff relationship between the number of routers and performance in this network, which proves that too little or too many routers both lead to low quality of experience. Our research, thus, analyzes this tradeoff and provides the optimal configuration that maximizes throughput.

Low Volume Neurolytic Retrocrural Celiac Plexus Block for Visceral Cancer Pain: Retrospective Review of 507 Patients with Severe Malignancy Related Pain Due to Primary Abdominal Cancer or Metastatic Disease

Abdominal pain from primary cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant to conventional analgesics. The need for timely pain relief in order to facilitate further care in the cancer treatment plan should be a priority. The aim of this retrospective observational review was to assess the relief given with a low volume neurolytic retrocrural celiac plexus nerve block, the duration of the procedure, the duration of relief, the reduction in daily opioid consumption, and the improvement of quality of life in a patient suffering from incapacitating abdominal pain due to primary abdominal malignancy or abdominal metastatic disease. Patients were given a neurolytic celiac plexus block without previous diagnostic block due to multiple comorbidities. This is a retrospective, observational study. Five hundred and seven patients were studied and data at 5 months for 455 patients were retained at the end of the review. They were evaluated in the pain center prior to and after the neurolytic retrocrural celiac plexus nerve block under fluoroscopic guidance. They were assessed on duration of procedure, pain scores (numeric rating scale 0-10), daily opioid consumption, quality of life improvement (simple yes or no question at 3 months) and routine follow-up during treatment for the cancer for 6 months or end of life. All data was gathered by extensive chart review and placed on a spreadsheet for analysis. Follow-up was completed 6 months after the procedure. Pain scores, daily opioid consumption, and quality of life showed improvement for the duration of the study. There was some return in pain during the fourth to sixth month due to disease progression and the anticipated duration of the neurolytic agent. Some short duration known side effects did occur. An initial vascular contrast uptake of 6.7% was noted during the procedure while utilizing digital subtraction angiography with fluoroscopy. A larger sample size would be ideal, as well as, a prospective trial with a control group, but this is unrealistic in our patient population. A proven quality of life questionnaire would be beneficial. Comparing alcohol, phenol and radiofrequency thermocoagulation would be interesting to equate duration, effect, and side effects. Low volume neurolytic retrocrural celiac plexus nerve block with phenol is a safe procedure providing up to 6 months of pain relief and is an effective, well-established, minimally time-consuming procedure for abdominal pain due to primary malignancy or metastatic spread. Celiac plexus, neurolytic, abdominal cancer pain, pain, retrocrural, cancer pain.

Grasping at Straws: Exploring PDVSA's Access to Debtor Relief Under Restructuring Regimes

Petroleos de Venezuela, S.A. (PDVSA), the state-owned oil company of the Bolivarian Republic of Venezuela, is undergoing significant financial distress. As evidenced by the heavily discounted prices of its publicly traded bonds, there is speculation concerning PDVSA’s ability to service its debts. While public debate has focused on the probability and implications of a default, little has been written about PDVSA’s possible use of debtor relief in order to restructure its liabilities. Thus, this paper seeks to explore the forms of debtor relief PDVSA may seek to avail itself of, and whether PDVSA may be eligible of such relief under the pertinent restructuring regimes. After assessing PDVSA’s assets, operations, liabilities, and legal form, this paper explains that all strategies considered would be fraught with considerable legal and practical challenges. Even if not insurmountable, such obstacles could provoke highly contentious, litigious proceedings. The paper is meant to be accessible to readers who have neither specialized in international bankruptcy, nor in PDVSA’s bonds or current circumstances. Therefore, specialists in either field may find this Paper overly descriptive or covering familiar ground.

The Study of the Relationship between Individual Perception of Loneliness and Socialization with Recreational Activities: A Research on University Students

Recreational activity is an important means of socialization, as well as providing psychological relief in order to achieve socialization and to overcome loneliness. Accordingly, the aim of the study is to analyze the relationship between the perception of loneliness and socialization with recreational activities. Another aim of this study is to analyze whether there is a statistically significant difference between the demographic variables and the sense of loneliness of the individuals. In this context, relations between variables were tested using the data based on the questionnaire applied to university students studying at state universities in Konya and the theoretical hypotheses were tested. In addition, in the analysis of the research, descriptive statistics, difference tests were used to determine the difference between demographic variables and loneliness perception and correlation analysis was used to determine the relation between loneliness variable and the variable of socialization with recreational activities. As a result of the analyses, it was detected that there was a positive and meaningful relationship between loneliness perception and the variable of socialization with recreational activities. In this respect, as mentioned in the findings, it was determined that the individuals who have perceptions of loneliness are trying to increase their level of socialization by participating in recreational activities.

ImPACTタフ・ロボティクス・チャレンジ(TRC)建設ロボット

As part of the Impulsing Paradigm Challenge through Disruptive Technologies Program (ImPACT)'s Tough Robotics Challenge Program, a group of research leaders at Osaka University, Kobe University, Tohoku University, Tohoku University, The University of Tokyo, Tokyo Institute of Technology, and Komatsu Ltd. developed a construction robot for disaster relief in order to solve various challenges of conventional construction machines used in such situations. Using a prototype machine with elemental technologies under development, verification tests were performed on places that represented disaster sites, and a certain level of performance was confirmed.

Família e clã nas narrativas patriarcais e na literatura profética: um breve comentário

Este artigo busca destacar, através de análise estrutural e de terminologias específicas do original hebraico, questões de gênero na criação do homem e da mulher, assim como seus papeis como esposo e esposa, pai e mãe na família nuclear e estendida, como exemplificado nas narrativas patriarcais e na Torá. São analisados os processos que envolvem a conformação do beit av bíblico e do clã, bem como os princípios subjacentes a sua estrutura, como a linhagem patrilinear, a sucessão agnática e suas dinâmicas específicas – a segmentação das linhagens e casamentos endogâmicos. O código clânico da vingança e resgate são apresentados a fim de se contextualizar o emprego da instituição do goel pelos profetas de Israel – suas relações de parentesco e atribuições – na formação de sua teologia da Salvação. Baseados nas obrigações inalienáveis do goel para com seu clã, os profetas instilaram, com sucesso, no povo de Judá a certeza de que Deus os redimirá do sofrimento e das tribulações.

Understanding patient and physician perceptions of benign prostatic hyperplasia in Asia Pacific, Latin America and the Commonwealth of Independent States: the Prostate Research on Behaviour and Education (PROBE) II survey.

SummaryAimTo assess attitudes and beliefs towards benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) and its treatment among patients and physicians in Latin America, Asia Pacific and the Commonwealth of Independent States (CIS).MethodsCross‐sectional, quantitative study conducted between December 2014 and September 2015. Separate questionnaires were administered to BPH/LUTS patients receiving drug treatment for their condition and to practising physicians who treat patients with BPH/LUTS.ResultsIn total, 1094 patients and 202 physicians completed a questionnaire. Most patients (61%) felt very/fairly well informed about BPH/LUTS, and 60% of physicians perceived patients to be very/somewhat informed. Overall, 70% of physicians felt that it would be valuable to raise awareness of BPH/LUTS and encourage men to consult a physician. The first symptoms most commonly noticed by patients were need to urinate more frequently, slower/weaker stream and nocturia. At first consultation, 71% of patients recalled providing a urine sample, 57% having a blood test for prostate‐specific antigen and 56% a digital rectal examination being performed. Over two thirds of patients (69%) were satisfied with their current medication; highest satisfaction rates (among both patients and physicians) were reported for alpha blockers and 5ARIs, either as monotherapies or used in combination. Patients were prepared to wait longer for symptom relief in order to have a reduced risk of surgery. Most physicians (90%) thought that at least some patients believe BPH/LUTS to be a progressive condition. Most physicians thought that patients were very/fairly concerned about BPH surgery (92%) and acute urinary retention (72%); 52% of physicians thought treatment adherence was “extremely” important.ConclusionsThis study provides valuable insights into the attitudes and beliefs of patients and physicians in Asia Pacific, Latin America and CIS about BPH/LUTS and its management. It also highlights areas of discordance between patient/physician perceptions and beliefs about BPH/LUTS, and potential areas of focus to improve the experience of affected patients.

Treinta años de ius publicum commune europeo en España

This dissertation briefly examines the process by which a body of common public law has been introduced in the Spanish legal system, over the last 30 years, under the influence of the EU law. The origins of that ius commune can be traced to the general principles recognized and applied by the European Court of Justice. In doing so, the ECJ has drawn first and foremost on common legal principles in the various EU member states. These general principles have taken a round-trip though: once they have been reshaped as a ‘European synthesis’, they have reenter the Member States legal systems as rules with a far reaching mandatory effect, binding national public bodies not only when they are implementing Union law, but also when their actions lay outside the scope of EU law. In order to explain this course, this paper proceeds through three different examples: the power and duty of national courts to apply interim relief in order to ensure the full effectiveness of EU law, Member State liability for breach of EU law and the doctrine of legitimate expectations.

Terrestrial Mobile Mapping: photogrammetric simulator

Abstract. Nowadays many types of sensors are used for terrestrial mobile mapping (TMM): IMU, odometers, GNSS, cameras, etc., and it is essential to understand how these sensors can improve the solution in terms of precision, accuracy and reliability. TMM issues are characterized by many variables: vehicle trajectory, the height of the buildings and the distance between them, traffic conditions, the presence or absence of trees, the level of illumination, etc. The aim of this study is to determine how photogrammetric measurements can improve the quality of TMM solution at least concerning magnitude and error propagation when there is no GNSS signal (for example in an urban canyon). Another purpose of the study was to determine the most suitable design project for a specific relief in order to obtain the best possible photogrammetric results. By analyzing the error propagation in the various components of relative orientation along the trajectory and considering a sequence of images characterized by an overlap varying between 60 to 90% and the same number of tie points, results were obtained which confirmed the reliability of the data produced by the simulator. These results are shown in this paper.

Essex and Herts Air Ambulance: a focused case series for pre-hospital practice Case 2: tension pneumothorax

A tension pneumothorax is an important reversible cause of deterioration in the multiply-injured patient, but it is not always easy to make the diagnosis. Features that indicate the development of a tension pneumothorax can be subtle in the spontaneously breathing patient. The ‘classical’ features may not all be present and in addition, the clinical signs of tension may develop over time with increasing patient compromise. This is a life-threatening situation, which requires relief in order to save the patient's life. A tension pneumothorax can be managed in one of three ways: needle decompression, insertion of an intercostal chest drain or by open thoracostomy. Needle decompression can be performed quickly and safely by paramedic crews using well-established techniques in both the conscious and unconscious patient. We describe a case of a 55-year-old male who was ejected from his motorcycle at high speed. He was conscious with a Glasgow Coma Score (GCS) of 15 and complaining of difficulty breathing. In contrast to the often quoted classical features of a tension pneumothorax, we review the more common clinical findings in tension pneumothoraces as illustrated in this case study. We aim to show that the diagnosis can be reached by careful history taking, examination, and attention to patient physiology. The case study also shows that a tension pneumothorax can be a dynamic developing situation in which patient compromise develops over time. We highlight that much can be done in the pre-hospital phase to treat such a patient while expediting transfer to hospital. We review the pre-hospital management of a tension pneumothorax and also describe our procedure for pre-hospital chest drain insertion in the context of effective teamwork between a paramedic road crew and an attending helicopter emergency medical service (HEMS).

Adjuvant spinal cord stimulation improves wound healing of peripheral tissue loss due to steal syndrome of the hand: clinical challenge treating a difficult case

Hand ischaemia due to arterial steal syndrome is an infrequent, but potentially serious complication of arteriovenous fistula (AVF) for haemodialysis. We present a case of hand ischaemia caused by steal syndrome in a 69-year-old haemodialysis patient, 10 months after a brachiobasilic fistula creation. The patient underwent multiple operations without resolution of hand pain and tissue loss. The implantation of an adjuvant cervical spinal cord stimulator allowed the patient to obtain complete hand pain relief and wound healing. Probably, the diffuse microangiopathy typical of haemodialysis patients could be responsible for the persistence of ischaemic signs and symptoms after a surgical revascularisation. The effect of sympathetic blockade and the subsequent improvement of the arterial blood flow and tissue oxygenation because of spinal cord stimulation (SCS) can be useful to achieve complete ischaemic pain relief in order to enhance wound healing and to limit the tissue loss. In conclusion, the association of cervical spinal cord stimulation and surgical revascularisation could represent a valid option to treat a critical upper limb ischaemia following steal syndrome due to AVF.

Vision of Resource, Structure, System and Chinese Food Security

Chinese food security has important strategic significance not only for native sustained economic and social development, but also has an important impact on world food security. At present, Chinese food security is facing three major issues which are serious resource constraints, complex structural contradictions and lag system supply. This paper presents the analytical framework of “resource • structure • System” and conducts theoretical and empirical analysis on the issue of food security in China by the method of system theory. The studies shows that the realization of food security in China should be based on its specific national conditions and reasonably and effectively combine resource allocation, structural optimization and system relief in order to provide continuous power for further enhancing the comprehensive support capacity of national food security.