Time Of Request Research Articles

A Comparison Between the Effectiveness of Ketamine Bolus and Intradermal Lidocaine in Reducing Acute Postoperative Pain

Background and objectiveIn light of the scarcity of data and research about the management of pain in a low-resource setting, we conducted this study with a view to assessing the effectiveness of intravenous ketamine in comparison to that of intradermal lidocaine in reducing postoperative pain. Postoperative pain can lead to significant morbidity, longer hospital stay, and the development of chronic pain. Our study was formulated to assess the effectiveness of a ketamine bolus in comparison to intradermal lidocaine at the wound site in terms of decreasing pain scores postoperatively.MethodsIn our study, 99 patients were randomly selected to undergo inguinal hernia repair under spinal anesthesia. After obtaining informed consent from the participants and approval from the hospital ethical committee, the patients were randomly classified into the following three groups: the lidocaine group (group A), the ketamine group (group B), and the control group (group C). The patients in the lidocaine group received 0.6 mL/kg of 0.25% lidocaine (1.5 mg/kg) infiltration at the wound site. The ketamine group was given a 50-mg ketamine bolus at the end of the operation, and the control group did not receive either ketamine or intradermal lidocaine at the wound site. Postoperative pain was recorded using the Visual Analog Scale (VAS) scoring and the results were compared. The time of the first request for analgesia was also recorded.ResultsThe pain scores measured via VAS scores were higher in patients who received intradermal lidocaine (group A) at the wound site as compared to group B that received a bolus of 50-mg ketamine (p<0.0001); the control group (group C) had pain scores higher than both groups A and B (p=0.0001).ConclusionBased on our findings, administering ketamine bolus can significantly decrease VAS scores and reduce the incidence of chronic post-surgical pain as compared to lidocaine infiltration. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, provides excellent pain relief and analgesia, which decreases overall pain scores.

The incidence of breakthrough pain associated with programmed intermittent bolus volumes for labor epidural analgesia: a randomized controlled trial

BackgroundIn this randomized, blinded study, we evaluated the effects of different programmed intermittent epidural bolus (PIEB) volumes for labor analgesia on the incidence of breakthrough pain and other analgesic outcomes. MethodsNulliparous women with term cephalic singleton pregnancies who requested labor analgesia had epidural analgesia initiated with 10 mL 0.1% ropivacaine with sufentanil 0.3 μg/mL. The pump was programmed to deliver a 4, 6 or 8 mL bolus every 45 min (groups 4, 6 or 8, respectively). The primary outcome was the incidence of breakthrough pain, defined as inadequate analgesia after two patient-controlled epidural analgesia administrations in a 20-min period. Secondary outcomes included ropivacaine consumption, time of the first patient-controlled epidural analgesia request, duration of the second stage of labor, and incidence of motor block. ResultsAmong 210 women randomly allocated the incidence of breakthrough pain was 34.9%, 19.7%, and 13.1%, for groups 4, 6 and 8, respectively (P=0.011). The incidence of breakthrough pain in group 8 was lower than in group 4 (P=0.006). The median (interquartile range) hourly ropivacaine consumption was 8.2 mg/h (7.1–11.3), 10.4 mg/h (9.2–13.0), and 12.0 mg/h (11.2–13.8) in groups 4, 6 and 8, respectively (P <0.001). Group 8 had a longer duration of effective analgesia and longer second stage of labor than group 4. There was no significant difference between groups in the incidence of motor block. ConclusionThe larger PIEB volumes were preferred for epidural labor analgesia compared with a smaller volume because of improved analgesia without clinically significant increases in adverse effects.

Erector spinae plane block versus thoracic epidural block as analgesic techniques for chest trauma

Background Effective analgesia, early mobilization, and respiratory support are the main goals for managing patients with rib fractures. The purpose of this study was to compare the differences between either continuous thoracic epidural and erector spinae plane (ESP) block in patients with chest trauma. Patients and methods This prospective study included 50 patients with American Society of Anesthesiologists status I and II, aged between 18 and 65 years old, admitted with chest trauma. The patients were randomly allocated into two equal groups: ESP block group and thoracic epidural analgesia group. A bolus dose of 15 ml of 0.125% bupivacaine was received in both groups and then continuous infusion was done by using 0.25% bupivacaine at the rate of 0.1 ml/kg/h for 48 h. The primary outcome was to evaluate analgesic efficacy all over the 48 h. Secondary outcomes were the total analgesic requirements during the 48 h, the time of first analgesic request, the effect on hemodynamic parameters, in addition to assessment of the amelioration in respiratory functions and inflammatory substance level between the two groups. Results Both groups had statistically significant decrease in the visual analog scale score after intervention compared with their pre-interventional values (P&lt;0.01), without statistically significant difference between them (P≥0.05). Moreover, hemodynamic parameter, pulmonary functions, and inflammatory substance levels showed statistical improvement (P&lt;0.01), but it was not statistically different between both groups (P≥0.05), except only mean arterial pressure values showed statistical significance between the two groups(P&lt;0.01). Conclusions ESP block is comparable to thoracic epidural in providing analgesia for patients with thoracic trauma.

Energy-aware and carbon-efficient VM placement optimization in cloud datacenters using evolutionary computing methods

One of the most critical concerns of cloud service providers is balancing renewable and fossil energy consumption. On the other hand, the policy of organizations and governments is to reduce energy consumption and greenhouse gas emissions in cloud data centers. Recently, a lot of research has been conducted to optimize the virtual machine placement on physical machines to minimize energy consumption. Many previous studies have not considered the deadline and scheduling of Internet of Things (IoT) tasks. Therefore, the previous modelings are mainly not well-suited to the IoT environments where requests are time-constraint. Unfortunately, both the sub-problems of energy consumption minimization and scheduling fall into NP-hard issues. This study proposes a multi-objective virtual machine placement to jointly minimize energy costs and scheduling. After presenting a modified Memetic algorithm, we compare its performance with baseline methods and state-of-the-art ones. The simulation results on the CloudSim platform show that the proposed method can reduce energy costs, carbon footprints, service-level agreement violations, and the total response time of IoT requests.

Evaluation of Effectiveness of Preemptive Intravenous Analgesics versus Postoperative TAP Block in Unilateral Inguinal Hernioplasty—A Prospective Randomized Double-Blind Clinical Trial

Abstract Aim The aim of this study was to compare the extent of analgesia in terms of duration of analgesia and requirement of postoperative analgesics with preemptive analgesia and transversus abdominis plane (TAP) block in patients undergoing inguinal hernioplasty. Materials and Methods Ninety male patients aged between 18 and 65 years of American Society of Anesthesiologists grades I and II undergoing open inguinal hernioplasty were randomly allocated to three comparable groups of 30 each. Control group (group C) received normal saline; preemptive group (group P) received inj. paracetamol, inj. diclofenac, and inj. Lignocaine; and TAP group (group T) received TAP block with 20 mL of 0.25% bupivacaine at the end of surgery. Parameters recorded were verbal numerical rating scale (VNRS) at rest at 4, 12, 24, and 48 hours and VNRS on movement at 12, 24, and 48 hours; heart rate and mean arterial pressure at 0, 4, 12, and 48 hours; time for first analgesic request; and total doses of analgesics consumed at 24 hours. Results Demographic data were comparable. VNRS on movement and number of doses of analgesics consumed at 24 hours were statistically less in group T (4.80 ± .761 hours); time for first request of analgesia was longer and this group had better patient satisfaction scores compared with other groups. Conclusion Both groups P and T provided better VNRS scores compared with group C. TAP block provided better VNRS scores on movement at 24 hours, lesser analgesic requirement, and better patient satisfaction score compared with other groups.

COMPARISON OF INTRAVENOUS DICLOFENAC SODIUM WITH OR WITHOUT PRE-EMPTIVE KETAMINE FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY UNDER SPINAL ANAESTHESIA. A COMPARATIVE MULTIMODAL ANALGESIA APPROACH

BACKGROUND AND AIMS: Pre-emptive analgesia is initiated before surgery in order to prevent the establishment of central sensitization during intra-operative and early post-operative period. Multimodal analgesia relates a balanced approach to treat post-operative pain by combining multiple therapeutic agents and regional techniques. This study was conducted to evaluate the post-operative analgesic efcacy and safety of intravenous water based diclofenac sodium with or without pre-emptive intravenous ketamine in patients undergoing total abdominal hysterectomy under spinal anaesthesia. METHODS: This was a prospective, randomized, double blinded controlled comparative tertiary hospital based study. Three groups of 30 patients each, i.e., receiving diclofenac with and without pre-emptive ketamine and control group were enrolled. The time of rst analgesic request, total analgesic requirement in rst 24h, intra-operative and post-operative vitals, any side effects and complication were recorded. RESULTS: Statistically signicant differences were observed in post-operative mean VAS scores between T30m to T24h, mean time of requirement of rst dose of rescue analgesia request was longer in patients in group DK (373±9.39 min.), as compared to group NS (179.13±5.95min.) and group D (228.30±7.97min.), post-operative requirement of analgesia in rst 24h was lower in group DK (1.27±0.45) as compared to group NS (2.86±0.44) and group D (1.67±0.55), and quality of analgesia among the three groups (p=0.001). CONCLUSION: Pre-emptive use of ketamine with intravenous diclofenac sodium as a part of multimodal analgesia regimen render the patient pain-free in immediate post-operative period and minimize the demand of rescue analgesic.

An Exact Algorithm for the Linear Tape Scheduling Problem

Magnetic tapes are often considered as an outdated storage technology, yet they are still used to store huge amounts of data. Their main interests are a large capacity and a low price per gigabyte, which come at the cost of a much larger file access time than on disks. With tapes, finding the right ordering of multiple file accesses is thus key to performance. Moving the reading head back and forth along a kilometer long tape has a non-negligible cost and unnecessary movements thus have to be avoided. However, the optimization of tape request ordering has rarely been studied in the scheduling literature, much less than I/O scheduling on disks. For instance, minimizing the average service time for several read requests on a linear tape remains an open question. Therefore, in this paper, we aim at improving the quality of service experienced by users of tape storage systems, and not only the peak performance of such systems. To this end, we propose a reasonable polynomial-time exact algorithm while this problem and simpler variants have been conjectured NP-hard. We also refine the proposed model by considering U-turn penalty costs accounting for inherent mechanical accelerations. Then, we propose a low-cost variant of our optimal algorithm by restricting the solution space, yet still yielding an accurate suboptimal solution. Finally, we compare our algorithms to existing solutions from the literature on logs of the mass storage management system of a major datacenter. This allows us to assess the quality of previous solutions and the improvement achieved by our low-cost algorithm. Aiming for reproducibility, we make available the complete implementation of the algorithms used in our evaluation, alongside the dataset of tape requests that is, to the best of our knowledge, the first of its kind to be publicly released.

Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries - A prospective double-blinded randomised controlled trial.

ABSTRACTBackground and Aims:Posterior lumbar spine fusion surgeries are associated with severe postoperative pain necessitating a multimodal analgesic regime. Wound infiltration with local anaesthetic is an accepted modality for postoperative analgesia in spine surgeries. Thoracolumbar interfascial plane (TLIP) block is a novel technique being evaluated for providing analgesia in lumbar spine surgeries. This study aimed to compare the analgesic efficacy of TLIP block compared to that of wound infiltration with local anaesthetic in terms of time to request the first dose of rescue analgesic.Methods:Seventy-one patients scheduled for posterior lumbar spine fusion under general anaesthesia were included in this double-blinded randomised controlled trial. Preoperatively, patients were randomly allocated to receive either a TLIP block (TLIP group) or wound infiltration (LI group). The primary endpoint was the time of the first request for rescue analgesia. Secondary endpoints were the total tramadol consumption and pain and comfort scores measured at various time points in the 48-h postoperative period. The trial was terminated after second interim analysis as the analgesic benefit of TLIP was evident both clinically and statistically.Results:The median (interquartile range) duration of the time of the first request for rescue analgesia was 1440 (1290, 2280) min in the TLIP group and 340 (180, 360) min in the infiltration group; P value <.001. The mean tramadol consumption was significantly higher in the infiltration group compared to the TLIP group, with a P value <.001.Conclusion:TLIP block provided better postoperative analgesia than that provided by wound infiltration with local anaesthetic.

Effects of fentanyl and dexmedetomidine as adjuvants to bupivacaine in paravertebral block for postoperative analgesia in patients undergoing modified radical mastectomy: A prospective randomised double-blind study.

ABSTRACTBackground and Aims:Paravertebral block (PVB) is an established method, indicated for postoperative analgesia after modified radical mastectomy (MRM). Although many additives to bupivacaine in PVB have been tried to prolong the analgesia in postoperative period, no additive has been found without any adverse effects. We have compared the duration of analgesia in PVB using adjuvants like dexmedetomidine and fentanyl with bupivacaine after MRM.Methods:A total of 60 female patients enroled for MRM were divided into two groups of 30 patients each. Group BF received PVB with 20 ml bupivacaine 0.25% with fentanyl 1 mg/kg and group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 mg/kg for PVB. After confirming successful PVB, surgery was done under general anaesthesia. Time for first rescue analgesic request was the primary outcome of the study. The secondary outcome was comparison of visual analogue scale scores for pain and total analgesic consumption. Side effects like sedation, nausea, vomiting, bradycardia and hypotension in the postoperative period till 24 h were also assessed.Results:The time for first rescue analgesic request was 6.32 ± 1.75 h in the BD group contrary to 3.94 ± 2.12 h in group BF (P < 0.05). Total paracetamol consumed as rescue analgesia in the first 24 h of postoperative period was remarkably reduced in group BD (1.7 ± 0.94 gm) in contrary to group BF (2.6 ± 0.98 gm) (P < 0.05). There was no significant difference in the incidence of complications between the groups.Conclusion:Dexmedetomidine provides prolonged postoperative analgesia compared with fentanyl when used as an adjuvant to bupivacaine in PVB after MRM.

Improve the Energy Efficiency of Datacenters With the Awareness of Workload Variability

In modern datacenters, huge energy consumption is a significant problem that remains to be solved. Previous works reduce the system energy consumption by switching the idle servers to a low-power state. However, the workload demands on servers change dynamically and mainly depend on the real-time workload status. To maintain the system energy efficiency, when providing servers with some servers reserved, the status of workloads should be carefully considered. Generally, the status of workloads is characterized by some key factors sampled from the workloads. However, under dynamic workload demands, the accuracy of these sampled values varies. To accurately assess the status of server workloads, in this paper, we propose a Dynamic Time Scale based server Provision (DTSP) method, which takes the variability of workloads into consideration when providing servers for workload demands. To obtain accurate factor values indicating real-time workload, DTSP samples several key workload factors, including the coefficient of variation of arrival intervals, the request arrival rates of current workload and previous workload, and the mean service time of current requests, with a dynamic compatible rate. With these sampled factors, DTSP can accurately estimate the demands of workloads on servers and provide appropriate numbers of servers for the dynamic workloads. Extensive experiments demonstrate that taking the workload variability into consideration, DTSP can significantly promote the energy efficiency of a datacenter.

Death with dignity utilization among patients with thoracic, head, and neck cancer.

12032 Background: Death with Dignity (DWD) legislation, which took effect in 2009 in Washington state, allows terminally ill patients (pts) to self-administer physician-prescribed, life-ending medication. Thoracic, head and neck cancer (THN) pts are among the top cancer types requesting DWD; however, data describing this group are limited. Methods: This retrospective chart review, conducted at Seattle Cancer Care Alliance/University of Washington and Fred Hutch, collected demographics, disease, treatment, support services and steps of the DWD process. We tested the association between disease characteristics of interest and DWD completion using Fisher’s Exact test. Results: Between Jan 2014 and October 2020, 498 pts inquired about DWD, and 108 (22%) were THN pts. Among THN pts, 51 (47%) only initiated the DWD request process, 35 (33%) only completed the DWD request process, and 22 (20%) completed the DWD request and self-administered the medication. Pts were white (n=90, 83%), male (n=64, 59%), primarily English speaking (n=103, 95%), nonreligious (n=69, 64%), single/divorced/non-partnered (n=55, 51%), and insured (n=103, 95%). Median age at request was 68 years (range 35-88). The table details THN DWD utilization. At time of DWD request, the median time from diagnosis was 14 months (range=0.2-242.7), and 62 (57%) had received ≥2 lines of therapy. Among 78 (72%) pts who received systemic therapy, 51 (65%) were ≥30 days from last therapy to time of death. Within 30 days prior to DWD request, 30 (28%), 25 (23%), and 7 (7%) pts saw social work, palliative care, and spiritual health respectively, and 35 (32%) were hospice-enrolled. Stage IV at diagnosis had higher rates of DWD medication use (p=0.05). There was no significant correlation between DWD medication use and primary site, ECOG score at request, insurance type, mental health diagnosis, use of depression/anxiety or pain medications, or hospice enrollment during DWD process. Conclusions: THN pts requesting DWD were predominantly white, nonreligious, insured males. Pts with advanced stage at diagnosis were more likely to use DWD medication. There was a higher proportion of DWD medication use with poorer performance status, and no association between use of depression/anxiety, pain medications, or utilization of supportive care services and DWD medication usage. Future research should investigate DWD utilization among THN pts in multiple centers and states to evaluate these patterns. [Table: see text]

CLINICAL EVALUATION OF EFFICACY AND SAFETY OF TRANSVERSUS ABDOMINIS PLANE BLOCK INJ. LEVOBUPIVACAINE AND INJ. ROPIVACAINE FOR POST OPERATIVE ANALGESIA FOLLOWING LOWER SEGMENT CESAREAN SECTION : A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND STUDY

Backgrounds and Aims :Levobupivacaine is a pure S-enantiomer of bupivacaine with similar anesthetic profile and with reduced toxic potential than racemic bupivacaine.This study aims to compare efficacy and safety of Transverse Abdominal Plane block inj. Levobupivacaine Vs. Inj. Ropivacaine for post operative analgesia following lower segment cesarean section. Methods and Material:A prospective, randomized, controlled, double blind clinical study. 60 patients divided in 2 groups by computer generated randomization.60 healthy women undergoing cesarean delivery under spinal anesthesia were randomized into two groups (Group I, Group II). Group I received TAP block with 15 ml of 0.25% ropivacaine while Group II received TAP block with 15 ml of 0.25% levobupivacaine on each side. Postoperatively, time for first request for rescue analgesia and number of women requesting analgesia in 6 h,8 h, 10 h, 12 h and 24 h were noted. Pain score was measured with the Visual Analogue Scale (VAS) at rest and on first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h. Statistical analysis used:The data were analyzed with Students t‑test. Results:The duration of analgesia was significantly prolonged in Group I than group II. The VAS score in patients who received Inj. Ropivacaine was significantly lower than who received inj. Levobupivacaine. Patient and surgeon satisfaction score were significantly higher in Ropicavaine than levobupivacaine. Conclusions:0.25% Ropivacaine provided longer duration of analgesia compared to 0.25% Levobupivacaine in TAP Block for postoperative analgesia after lower segment cesarean section.

Timing of Requests for Medical Assistance in Case of Difficult Airway Management - Based on a Case That Occurred during Tracheostomy in an Emergency Room -

Timing of Requests for Medical Assistance in Case of Difficult Airway Management - Based on a Case That Occurred during Tracheostomy in an Emergency Room -

Load balancing in cloud environment using enhanced migration and adjustment operator based monarch butterfly optimization

In the decades before the advent of computers, humans tend to make mistakes while calculating and remembering tasks. Distributed computing helped to reduce the workload of each computer by distributing the workload evenly among computers connected in the network. Cloud computing have eradicated most of the problems that occurred in distributed computing but were also prone to different types of issues. Major issues in cloud computing relate to security and load balancing. Load balance of a node relates to two important parameters namely request time and response time. Meta heuristics algorithms can be used to provide proper load balancing techniques in cloud. This paper provides a mechanism namely EMAMBO to ensure that each node is properly load-balanced in cloud. Based on different metrics considered, it could be inferred that the proposed system fares better when compared to different benchmarked existing systems.

Prilocaine Fentanyl versus Bupivacaine-Fentanyl in Subarachnoid Anesthesia for Lower Abdominal Surgeries

Introduction and aim: Spinal anesthesia is a commonly and conveniently used for lower abdominal surgeries. The research on different drugs for spinal anesthesia is still ongoing to find out the standard and ideal drug. The current work aimed to compare efficacy and safety profile between prilocaine versus bupivacaine in spinal anesthesia for lower abdominal surgeries.&#x0D; Methodology: Ninety patients scheduled for elective lower abdominal surgeries were included and randomly assigned to one of two equal groups. All patients were preoperatively assessed by clinical and laboratory investigations. Hemodynamic monitoring was assessed intraoperatively every 5 minutes. Sensory and motor blockade and postoperative pain and time for first analgesic request were recorded. The primary outcomes were efficacy of block (onset of sensory block, onset and intensity of motor block and duration of action). The Secondary outcomes were hemodynamic changes, post-operative analgesia, and patient satisfaction.&#x0D; Results: The time for the onset of the highest sensory block was shorter among P than B group (5.91±1.84 vs 8.26±1.98 minutes, respectively). Similarly, the time for the onset of the highest motor block level and PACU length of stay (minutes) was significantly shorter among P than B groups. The postoperative pain score was reduced in P than B group. The time for first analgesic request was shorter among P than B group (192.44±11.21 vs 235.77±29.44 minutes). Sensory regression to L1 was shorter among P than B groups. The motor regarrisons at one hour showed significant difference. The postoperative systolic blood pressure was significantly reduced in B than P group, with increased hypotension in B than P group (17.8% vs 4.4%, respectively). On the other side, no significant difference was observed for other complications or satisfaction score.&#x0D; Conclusion: The combination of prilocaine and fentanyl is superior than bupivacaine and fentanyl for subarachnoid anesthesia in lower abdominal surgery.

Identification of Asymmetric DDoS Attacks at Layer 7 with Idle Hyperlink

Asymmetric denial-of-service (DDoS) attacks have become very complicated to deal with because of the use of several Internet Protocol (IP) addresses in these types of attacks. The purpose of research is different strategies are used by an attacker to achieve the objective of forcing the unavailability of the targeted server. Sometimes the large size of the file is used with a higher transfer rate so that the targeted website could be hanged for a legitimate customer. The design of a novel mechanism, in the form of Dynamic Honey Link (DHL), to prevent identification by sophisticated DDoS attacking tools, the findings this developed here for the detection of asymmetric attacks. Parameters such as IP addresses, Time of Request, and difference of time between requests of IPs are used in this mechanism and are verified applying correlation coefficients and p-values. This new analysis of different website attacks using an analysis of dataset leads to inspection and identification of hyperlinks.

Factors influencing interhospital transfer delays in emergency general surgery: a systematic review and narrative synthesis.

Emergency general surgery is an emerging public health issue globally, with substantial healthcare burden. Interhospital transfer of critically unwell surgical patients has been the mainstay of bridging gaps in surgical coverage in regional and rural locations, despite evidence of greater morbidity and mortality. Delays in transfer invariably occurs and compounds the situation. Our aim was to examine the factors influencing interhospital transfer delays in emergency general surgical patients. A systematic search of PubMED and EmBase, was performed by two researchers from 2020 to 23rd Feb 2021, for English articles related to interhospital transfer delays in emergency general surgical patients, with an age of >16. Articles were critically appraised and data were extracted into a pre-specified data extraction form. No data was suitable for statistical analysis and a narrative synthesis was performed instead. Six relevant articles were identified from the search. All studies were retrospective cohort studies with moderate to high risk of bias. Lack of consultant surgeon input, after hours transfer, need for intensive care bed and poor transfer documentation may have a role in interhospital transfer delays. Patients with public health insurance, multiple comorbidities and non-emergency medical conditions experience longer transfer request time and may be at risk of precipitating interhospital transfer delays. Transfer delays are seen in transfers over longer distances. There is a paucity of knowledge on what and how factors influence interhospital transfer delays in emergency general surgical patients. Well-designed prospective cohort studies are required to bridge this knowledge gap.

The Effect of Intraoperative Infusion of Dexmedetomidine on Acute and Chronic Postoperative Pain After Simple Mastectomy: A Randomized Double-Blind Clinical Trial

Background: Postoperative pain is a common expected problem. Appropriate medications are important to control pain, especially in breast cancer surgery with a high rate of postoperative acute and chronic pain. Objectives: This study aimed to evaluate the effect of intraoperative infusion of dexmedetomidine on acute and chronic pain after simple mastectomy. Methods: This is a double-blind clinical trial study which included 110 eligible patients for simple mastectomy from Shahid Faghihi Educational and Medical Center in Shiraz between October 2018 and May 2019. The patients were randomized into two groups of intervention who were received intraoperative dexmedetomidine 0.4 μg/kg/h, and control group who were received the same amount of placebo (normal saline 0.9%). The severity of acute and incidence of chronic pain were assessed with VAS of pain, and brief pain inventory (BPI), and the number of analgesics (Apotel, Morphine) that patients received in first 24 hours were recorded postoperatively. Collected data were analyzed, and P-values of less than 0.05% were considered statistically significant. Results: Here, 110 patients (55 people in each group) were met the inclusion criteria of the study. Based on the result of this study, the mean VAS score of pain in the intervention group (0.96 ± 0.14) was significantly lower than the control group (4.44 ± 2.25) (P &lt; 0.001). Although the incidence of chronic pain was different between the two groups after three months, this difference was not statistically significant (P = 0.871). Moreover, the number of requests and the amount of analgesia (Apotel and Morphine) in the first 24 hours after surgery in patients in the intervention group was significantly less than patients in the control group (P &lt; 0.001). Also, the time of the first request for analgesia (Apotel, Morphine) in the patients of the intervention group was significantly longer than the control group (P-value = 0.036). Conclusions: According to the finding of this study, the use of dexmedetomidine during simple mastectomy reduces pain, decreases, and delays in requirement of analgesia at the first 24 hours post-operation. However, it did not have a significant effect on chronic pain.

On the impact of stale information on distributed online load balancing protocols for edge computing

The distributed nature of edge computing infrastructures requires a significant effort to avoid overload conditions due to uneven distribution of incoming load from sensors placed over a wide area. While optimisation algorithms operating offline can address this issue in the medium to long term, sudden and unexpected traffic surges require an online approach where load balancing actions are taken at a smaller time scale. However, when the service time of a single request becomes comparable with the latency needed to take and actuate load balancing decisions, the design of online approaches becomes particularly challenging.This paper focuses on the class of online algorithms for load balancing based on resource sharing among random nodes. While this randomisation principle is a straightforward and effective way to share resources and achieve load balance, it fails to work properly when the interval between decision making and decision actuating times (called schedule lag) becomes comparable with the time required to execute a job, a condition not rare in edge computing systems, and provokes stale (out-of-date) information to be involved in scheduling decisions. Our analysis combines (1) a theoretical model that evaluates how stale information reduces the effectiveness of the balancing mechanism and describes the correlation between the system state at decision making and decision actuating times; (2) a simulation approach to study a wide range of algorithm parameters and possible usage scenarios. The results of our analysis provides the designers of distributed edge systems with useful hints to decide, based on the scenario, which load balancing protocol is the most suitable.

Effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia: A prospective cohort study, Ethiopia

BackgroundFollowing cesarean delivery, mothers experience moderate to severe pain since postoperative analgesia of spinal anesthesia is limited by duration of local anesthetic agents used. Analgesic effect of local anesthetic agents could be extended and supported by adding either intravenous or intrathecal adjuvants. The primary outcome of this study is to assess effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia. Materials and methodsThis prospective observational cohort study recruits 60 parturients who underwent elective cesarean delivery under spinal anesthesia. Those parturients who received intravenous ketamine 0.25 mg/kg following spinal anesthesia were considered as exposed group/ketamine group. The Non-exposed group was those parturients who didn't receive intravenous ketamine following spinal anesthesia. Numerical rating scale pain score, time to request first analgesia and total analgesia consumptions were recorded starting from 1st hour to 24 h after the end of surgery. ResultsThe median and Inter quartile range (IQR) for postoperative numerical rating scale pain score was significantly higher in non-exposed group compered to ketamine group at 1st and 2nd hour after operation (P-value<0.05). Time to request first analgesia was significantly longer in ketamine group [192.5(140–210) minutes] compared to non-Exposed group [146(130–160) minutes] with P-value < 0.001. Tramadol consumption within 24 h postoperatively were significantly lower in ketamine group compared to non-exposed group (P-value < 0.001). ConclusionLow dose intravenous ketamine before skin incision was extended postoperative first analgesia request time by average of 45.5 min and decrease total analgesia consumption in 24 h.