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1.
Nano Lett ; 24(32): 9889-9897, 2024 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-38985008

RESUMEN

Recently, 2D semiconductor-based optoelectronic memory has been explored to overcome the limitations of conventional von Neumann architectures by integrating optical sensing and data storage into one device. Persistent photocurrent (PPC), essential for optoelectronic memory, originates from charge carrier trapping according to the Shockley-Read-Hall (SRH) model in 2D semiconductors. The quasi-Fermi level position influences the activation of charge-trapping sites. However, the correlation between quasi-Fermi level modulations and PPC in 2D semiconductors has not been extensively studied. In this study, we demonstrate optoelectronic memory based on a 2D semiconductor-polymer hybrid structure and confirm that the underlying mechanism is charge trapping, as the SRH model explains. Under light illumination, electrons transfer from polyvinylpyrrolidone to p-type tungsten diselenide, resulting in high-level injection and majority carrier-type transitions. The quasi-Fermi level shifts upward with increasing temperature, improving PPC and enabling optoelectronic memory at 433 K. Our findings offer valuable insights into optimizing 2D semiconductor-based optoelectronic memory.

2.
Subst Use Misuse ; 59(1): 119-125, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37807726

RESUMEN

Background: Medical marijuana legalization (MML) has been widely implemented in the past decade. However, the debates regarding the consequences of MML persist, especially criminal behaviors. Objectives: We examined the association between MML and criminal behaviors among adults in the United States. The criminal behaviors measured three past-year offenses: whether the adult (1) have sold illegal drugs, (2) have stolen anything worth > $50 USD, or (3) have attacked someone. Methods: Using the 2015-2020 National Survey of Drug Use and Health, we included 214,505 adults in our primary analysis for 2015-2019 and 27,170 adults in 2020 for supplemental analysis (age > = 18). Weighted multivariable logistic regression models were used to examine the association between MML and three criminal behaviors. Results: In our primary analysis, we observed no statistically significant association between MML and the three outcomes of criminal behavior. Nevertheless, our supplemental analysis of the 2020 data showed MML was associated with increasing odds of the three criminal behaviors (have sold illegal drugs: AOR [adjusted odds ratio] = 1.7; have stolen anything worth > $50 USD: AOR = 1.9; have attacked someone: AOR = 1.8; all p < 0.05). Conclusion: Surveys from 2015 to 2019 did not suggest MML as a risk factor for higher incidence of criminal behaviors. However, 2020 data showed statistically significant association between MML and selected criminal behaviors. Issues related to the COVID-19 pandemic, such as the U.S. economic downturn, could potentially explain this discrepancy. Further research efforts may be warranted.


Asunto(s)
Drogas Ilícitas , Fumar Marihuana , Marihuana Medicinal , Adulto , Humanos , Estados Unidos/epidemiología , Pandemias , Legislación de Medicamentos , Conducta Criminal , Fumar Marihuana/epidemiología
3.
Anesth Analg ; 136(3): 597-604, 2023 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-36727847

RESUMEN

BACKGROUND: The pericapsular nerve group (PENG) block was recently suggested as a regional technique for managing acute pain after hip surgery. However, few anatomical studies have confirmed the spread of injectate during the PENG block. This cadaver study aimed to analyze injectate spread to the target nerves during single-injection ultrasound-guided PENG block. METHODS: Ultrasound-guided PENG block with 3 different injectate volumes (10, 20, or 30 mL) was performed in 18 cadavers. Injectate spread by the volume was first evaluated on computed tomography, followed by cadaver dissection. The spread of the dye over the pelvis and lower limb was evaluated. RESULTS: The articular branches of the femoral nerve were stained nearly sufficiently with 20- and 30-mL specimens. The femoral nerve itself was stained simultaneously in six of 12 (50%) 20-mL specimens and 12 of 12 (100%) 30-mL specimens. The accessory obturator nerve was observed only in three (9%) of 36 specimens. The articular branches of the obturator nerve were rarely affected, regardless of injectate volume (1/12, 10 mL specimens; 2/12, 20 mL specimens; 1/12, 30 mL specimens; P > .999). Rather, the obturator nerve was affected. However, the obturator nerve was not stained consistently even with 30 mL of injectate (50%). CONCLUSIONS: After combining the dissection and radiological findings, the single-injection ultrasound-guided PENG blocks with volumes of 10, 20, and 30 mL do not support motor sparing or selective anterior hip capsule innervation in a clinical setting. If early rehabilitation is needed, high-volume PENG block might not be the ideal option, and persisting pain after PENG block might be attributed in part to the lack of obturator nerve articular branches blockade.


Asunto(s)
Nervio Femoral , Bloqueo Nervioso , Humanos , Ultrasonografía Intervencional/métodos , Bloqueo Nervioso/efectos adversos , Bloqueo Nervioso/métodos , Nervio Obturador/diagnóstico por imagen , Cadáver
4.
BMC Public Health ; 23(1): 2273, 2023 11 17.
Artículo en Inglés | MEDLINE | ID: mdl-37978483

RESUMEN

BACKGROUND: Sub-Saharan African countries, Nigeria inclusive, are constrained by grossly limited access to quality pre-hospital trauma care services (PTCS). Findings from pragmatic approaches that explore spatial and temporal trends of past road crashes can inform novel interventions. To improve access to PTCS and reduce burden of road traffic injuries we explored geospatial trends of past emergency responses to road traffic crashes (RTCs) by Lagos State Ambulance Service (LASAMBUS), assessed efficiency of responses, and outcomes of interventions by local government areas (LGAs) of crash. METHODS: Using descriptive cross-sectional design and REDcap we explored pre-hospital care data of 1220 crash victims documented on LASAMBUS intervention forms from December 2017 to May 2018. We analyzed trends in days and times of calls, demographics of victims, locations of crashes and causes of delayed emergency responses. Assisted with STATA 16 and ArcGIS pro we conducted descriptive statistics and mapping of crash metrics including spatial and temporal relationships between times of the day, seasons of year, and crash LGA population density versus RTCs incidence. Descriptive analysis and mapping were used to assess relationships between 'Causes of Delayed response' and respective crash LGAs, and between Response Times and crash LGAs. RESULTS: Incidences of RTCs were highest across peak commuting hours (07:00-12:59 and 13:00-18:59), rainy season and harmattan (foggy) months, and densely populated LGAs. Five urban LGAs accounted for over half of RTCs distributions: Eti-Osa (14.7%), Ikeja (14.4%), Kosofe (9.9%), Ikorodu (9.7%), and Alimosho (6.6%). On intervention forms with a Cause of Delay, Traffic Congestion (60%), and Poor Description (17.8%), had associations with LGA distribution. Two densely populated urban LGAs, Agege and Apapa were significantly associated with Traffic Congestion as a Cause of Delay. LASAMBUS was able to address crash in only 502 (36.8%) of the 1220 interventions. Other notable outcomes include: No Crash (false calls) (26.6%), and Crash Already Addressed (22.17%). CONCLUSIONS: Geospatial analysis of past road crashes in Lagos state offered key insights into spatial and temporal trends of RTCs across LGAs, and identified operational constraints of state-organized PTCS and factors associated with delayed emergency responses. Findings can inform programmatic interventions to improve trauma care outcomes.


Asunto(s)
Accidentes de Tránsito , Ambulancias , Humanos , Nigeria/epidemiología , Estudios Transversales , Factores de Riesgo
5.
Opt Lett ; 47(1): 106-109, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34951891

RESUMEN

To efficiently access light waves confined in a high-quality-factor (Q) microcavity over a wide spectral range, it is necessary to independently control coupling efficiency at different wavelengths. Here we suggest an approach to add a degree of freedom to control the coupling efficiency based on a two-point coupling geometry. By changing the phase difference between two paths connecting two coupling points, various combinations of coupling efficiencies at multiple wavelengths can be achieved. An analytic model describing the coupling property is derived and confirmed by experimental results. It is also shown that the coupling property can be modified by adjusting the effective refractive index difference between a waveguide and a resonator.

6.
Int J Med Sci ; 19(6): 1056-1064, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35813289

RESUMEN

Background: Endoscopic transsphenoidal pituitary surgery has shown promising results. However, fast and high-quality recovery after this procedure remains a challenge for neuroanesthesiologists. This study aimed to compare the quality of recovery after transsphenoidal pituitary surgery between patients who received inhalational anesthesia with sevoflurane and patients who received propofol-based total intravenous anesthesia (TIVA). Methods: Eighty-two patients undergoing transsphenoidal pituitary surgery were randomized to receive either sevoflurane inhalation with manual infusion of remifentanil (sevoflurane group) or effect-site target-controlled infusion of propofol and remifentanil (TIVA group). The primary outcome was the 40-item Quality of Recovery (QoR-40) score on postoperative day 1. The QoR-40 questionnaire was completed by patients the day before surgery and on postoperative days 1 and 2. Emergence agitation and recovery characteristics were also assessed. Results: There were no significant differences between the groups in the global QoR-40 scores on both postoperative days 1 and 2 (difference -8.7, 95% CI -18.0 to 0.7, and P = 0.204; -3.6, 95% CI -13.0 to 5.8, and P > 0.999, respectively). The time to verbal response and time to extubation were significantly shorter in the sevoflurane group than in the TIVA group (P < 0.001 and P < 0.001, respectively). However, the incidence of emergence agitation was lower in the TIVA group than in the sevoflurane group (P < 0.001). Conclusions: Both inhalational anesthesia with sevoflurane and propofol-based TIVA were appropriate anesthetic techniques for patients undergoing endoscopic transsphenoidal pituitary surgery in terms of the quality of recovery up to 2 days postoperatively. Rapid emergence was observed in the sevoflurane group, while smooth emergence was observed in the TIVA group.


Asunto(s)
Anestésicos por Inhalación , Delirio del Despertar , Propofol , Anestesia Intravenosa/métodos , Anestésicos Intravenosos , Delirio del Despertar/tratamiento farmacológico , Humanos , Remifentanilo , Sevoflurano
7.
Int J Med Sci ; 19(6): 1029-1035, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35813291

RESUMEN

Adhesiolysis is minimally invasive and commonly used for pain associated with adhesion after lumbar spine surgery. Caudal epidural block may be used for radiating pain due to failed back surgery syndrome. We evaluated the predictive value of response to caudal block performed prior to adhesiolysis in failed back surgery syndrome. Between January 1, 2013 and June 30, 2020, 150 patients with failed back surgery syndrome were treated with adhesiolysis using a steerable catheter at the pain clinic of a tertiary hospital after failed conservative treatment (including caudal block). Patient demographics, pain duration, and lumbar magnetic resonance imaging findings were examined. Response to previous caudal block was determined as a binary result (yes or no). Patients were followed up 3 months after adhesiolysis. Successful outcome was defined as a ≥2-point reduction in the numeric rating scale scores for radicular pain 3 months after adhesiolysis, evident in 81/150 (46%) patients. Multivariable logistic regression analysis revealed that caudal block response was an independent predictor of successful adhesiolysis (odds ratio = 4.403; p = 0.015). Response to prior caudal block is a positive predictor of successful adhesiolysis.


Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar , Dolor de la Región Lumbar , Catéteres , Síndrome de Fracaso de la Cirugía Espinal Lumbar/cirugía , Humanos , Inyecciones Epidurales/métodos , Dolor de la Región Lumbar/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
8.
Opt Lett ; 46(7): 1772-1775, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33793540

RESUMEN

Reducing the complexity required for starting and maintaining a soliton state has been a major task to fully miniaturize soliton microcombs including the accompanying external operating systems. Here we experimentally examine the generative process of a self-stabilized soliton in which a continuous-wave pump detuned on the thermally stable blue side of a resonance generates a Brillouin lasing signal that relays the pump power to the soliton pulses via intracavity mode-coupling without breaking thermal self-stability. Based on a simple setup consisting of a free-running laser and a microcavity without any external feedback systems by virtue of internal thermal locking, single-soliton pulses of 11 GHz repetition rate were deterministically generated. We demonstrate that the single-soliton pulses can be passively maintained over several days in a laboratory environment with a phase noise performance of -137dBc/Hz at 100 kHz.

9.
BMC Anesthesiol ; 21(1): 21, 2021 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-33461484

RESUMEN

BACKGROUND: Radial artery cannulation can cause complications such as haematoma formation or thrombosis due to its small diameter. Recently, a novel ultrasound device equipped with an electromagnetic guidance system was introduced, showing the path and alignment of the needle during the procedure. The aim of this study was to investigate the effects of this novel system on both success and complication rates during radial artery cannulation under ultrasound guidance. METHODS: In this randomized controlled trial, 76 adults scheduled for neurosurgery requiring radial artery cannulation were recruited. In group E (n = 38), radial artery cannulation was performed using the electromagnetic guidance ultrasound system, whereas in group C (n = 38), the procedure was performed using conventional ultrasound guidance. The success rates of cannulation on the first attempt, cannulation times, number of attempts, and incidence of complications were compared between the two groups. RESULTS: There was a significant difference in the success rates on the first attempt between the two groups (group C = 78.9% vs. group E = 94.7%, P = 0.042). Incidences of posterior wall puncture and haematoma formation (group C = 8 vs. group E = 1; P = 0.028) were significantly lower in group E than in group C. The median cannulation time for successful attempts was comparable between groups. CONCLUSIONS: Use of the novel electromagnetic guidance system resulted in a better success rate on the first attempt and a lower incidence of complications during radial artery cannulation. TRIAL REGISTRATION: This study was registered at http://cris.nih.go.kr (registration number: KCT0002476 ).


Asunto(s)
Cateterismo Periférico/métodos , Diseño de Equipo/métodos , Arteria Radial/diagnóstico por imagen , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/métodos , Fenómenos Electromagnéticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
10.
Eur J Anaesthesiol ; 38(4): 394-401, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33122575

RESUMEN

BACKGROUND: Spinal anaesthesia-induced hypotension is frequently reported in patients undergoing caesarean section. Mechanistically, sympathetic blockade reduces the systemic vascular resistance and the left ventricular preload, causing hypotension, which is augmented by aortocaval compression. The corrected blood flow time (FTc) is affected by the preload and is inversely related to the afterload. OBJECTIVE: We hypothesised that the preanaesthetic carotid artery FTc could predict hypotension after induction in patients undergoing a caesarean section with spinal anaesthesia. DESIGN: A prospective observational study. SETTING: A tertiary referral centre in South Korea from September 2018 to November 2019. PARTICIPANTS: Thirty-eight parturients scheduled for elective caesarean section under spinal anaesthesia. INTERVENTIONS: Using carotid ultrasonography, FTc was measured twice prior to inducing spinal anaesthesia. FTc was calculated using both Bazett's (B) and Wodey's (W) formulae. Hypotension was defined as an SBP decrease to less than 80 mmHg, or less than 75% of baseline, or if symptoms consistent with hypotension occurred from the time of injection of the spinal anaesthetic until delivery. MAIN OUTCOME MEASURES: The primary endpoint was to determine the predictive value of preanaesthetic FTc for postspinal hypotension during caesarean delivery. RESULTS: Among the 35 patients who completed this study, hypotension occurred in 21 (60%). The areas under the receiver-operating characteristic curves for FTc (B) and FTc (W) were 0.905 [95% confidence interval (CI), 0.757 to 0.978, P < 0.001] and 0.922 (95% CI, 0.779 to 0.985, P < 0.001), respectively. The optimal cut-off values for predicting hypotension were 346.4 and 326.9 ms, respectively. The grey zone for FTc (B) and FTc (W) included 40 and 14% of the patients, respectively. CONCLUSION: Preanaesthetic carotid artery FTc was a reliable indicator of postspinal hypotension in parturients. Considering the grey zone, Wodey's formula is better than Bazett's formula. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03631329.


Asunto(s)
Anestesia Obstétrica , Anestesia Raquidea , Hipotensión , Anestesia Obstétrica/efectos adversos , Anestesia Raquidea/efectos adversos , Arterias Carótidas , Cesárea/efectos adversos , Femenino , Humanos , Hipotensión/diagnóstico , Hipotensión/etiología , Embarazo , República de Corea
11.
Small ; 16(41): e2002641, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32964649

RESUMEN

Bipolar membranes (BPMs) have recently received much attention for their potential to improve the water dissociation reaction (WDR) at their junction by utilizing catalysts. Herein, composite catalysts (Fe2 O3 @GO) comprising hematite nanoparticles (α-Fe2 O3 ) grown on 2D graphene oxide (GO) nanosheets are reported, which show unprecedentedly high water dissociation performance in the BPM. Furthermore, new catalytic roles in facilitating WDR at the catalyst-water interface are mechanistically elucidated. It is demonstrated that the partially dissociated bound water, formed by the strongly Lewis-acidic Fe atoms of the Fe2 O3 @GO catalyst, helps the "ice-like water" to become tighter, consequently resulting in weaker intramolecular OH bonds, which reduces activation barriers and thus significantly improves the WDR rate. Notably, Fe2 O3 @GO-incorporated BPM shows an extremely low water dissociation potential (0.89 V), compared to commercially available BPM (BP-1E, 1.13 V) at 100 mA cm-2 , and it is quite close to the theoretical potential required for WDR (0.83 V). This performance reduces the required electrical energy consumption for water splitting by ≈40%, as compared to monopolar (Nafion 212 and Selemion AMV) membranes. These results can provide a new approach for the development of water dissociation catalysts and BPMs for realizing highly efficient water splitting systems.

12.
Anesth Analg ; 130(2): 480-487, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-30320644

RESUMEN

BACKGROUND: Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. METHODS: We recruited 100 patients, 65-90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible, <50% visual obstruction of epiglottis to vocal cords; vocal cords and posterior epiglottis visible; and vocal cords visible. We also investigated success rate and ease of insertion, insertion time, and manipulations during insertion as insertion variables, complications during maintenance and emergence periods, and postoperative pharyngolaryngeal complications including sore throat, dysphagia, and dysphonia. RESULTS: After assessing for eligibility, 48 patients were allocated to each group. Oropharyngeal leak pressures were significantly higher in the i-gel group than in the self-pressurized air-Q group (P < .001) at the 2 measurement points. The raw mean difference at initial assessment and the median difference after 10 minutes were 5.5 cm H2O (95% confidence interval, 3.3-7.6 cm H2O) and 5.0 (95% confidence interval, 2.0-7.0 cm H2O), respectively. The initial scores of fiberoptic view were similar in the 2 groups. However, the self-pressurized air-Q supraglottic airway provided a significantly improved fiberoptic view at 10 minutes after initial assessment (P = .030). We found no statistically significant differences in insertion variables and complications between the 2 groups. CONCLUSIONS: The i-gel provided better sealing function than the self-pressurized air-Q supraglottic airway according to the high oropharyngeal leak pressures in elderly patients during general anesthesia. The self-pressurized air-Q supraglottic airway had improved fiberoptic views in elderly patients during general anesthesia.


Asunto(s)
Manejo de la Vía Aérea/normas , Anestesia General/normas , Intubación Intratraqueal/normas , Máscaras Laríngeas/normas , Anciano , Anciano de 80 o más Años , Manejo de la Vía Aérea/instrumentación , Anestesia General/instrumentación , Femenino , Humanos , Intubación Intratraqueal/instrumentación , Masculino , Estudios Prospectivos
13.
Sensors (Basel) ; 20(18)2020 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-32899543

RESUMEN

In recent years, research and development of autonomous driving technology have gained much interest. Many autonomous driving frameworks have been developed in the past. However, building a safely operating fully functional autonomous driving framework is still a challenge. Several accidents have been occurred with autonomous vehicles, including Tesla and Volvo XC90, resulting in serious personal injuries and death. One of the major reasons is the increase in urbanization and mobility demands. The autonomous vehicle is expected to increase road safety while reducing road accidents that occur due to human errors. The accurate sensing of the environment and safe driving under various scenarios must be ensured to achieve the highest level of autonomy. This research presents Clothoid, a unified framework for fully autonomous vehicles, that integrates the modules of HD mapping, localization, environmental perception, path planning, and control while considering the safety, comfort, and scalability in the real traffic environment. The proposed framework enables obstacle avoidance, pedestrian safety, object detection, road blockage avoidance, path planning for single-lane and multi-lane routes, and safe driving of vehicles throughout the journey. The performance of each module has been validated in K-City under multiple scenarios where Clothoid has been driven safely from the starting point to the goal point. The vehicle was one of the top five to successfully finish the autonomous vehicle challenge (AVC) in the Hyundai AVC.

14.
Int J Hyperthermia ; 36(1): 1-8, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30354794

RESUMEN

INTRODUCTION: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an α2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery. OBJECTIVE: To assess the effect of dexmedetomidine on renal function after CRS and HIPEC. MATERIALS: Thirty-eight patients undergoing CRS and HIPEC were randomized to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1 µg/kg over 20 min followed by infusion at 0.5 µg/kg/h) or 0.9% sodium chloride (control group, n = 19) during surgery. Creatinine clearance (CrCl) was assessed daily until postoperative day 7. Urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1 were measured for 24 h after surgery. RESULTS: There was no difference in the lowest CrCl value during the first 7 days postoperatively, but the % change from baseline to the lowest value was lower in the dexmedetomidine group than in the control group (p = .037). Urine NGAL and KIM-1 levels were increased over time in both groups, but the increases were significantly less in the dexmedetomidine group (p = .018 and 0.038, respectively). In the dexmedetomidine group, the length of intensive care unit stay was shorter (p = .034). CONCLUSIONS: Intraoperative dexmedetomidine infusion did not improve renal function in terms of serum Cr-related indices following CRS and HIPEC. However, as the decrease in CrCl was attenuated and early tubular-injury markers were lower in the dexmedetomidine group, dexmedetomidine may have protective effects against early tubular injury in CRS and HIPEC. Clinical Trials Registry: http://clinicaltrials.gov (NCT02641938).


Asunto(s)
Procedimientos Quirúrgicos de Citorreducción/métodos , Dexmedetomidina/uso terapéutico , Hipertermia Inducida/métodos , Hipnóticos y Sedantes/uso terapéutico , Riñón/efectos de los fármacos , Dexmedetomidina/farmacología , Femenino , Humanos , Hipnóticos y Sedantes/farmacología , Masculino , Persona de Mediana Edad
15.
Int J Med Sci ; 16(3): 376-383, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30911271

RESUMEN

Background: Combination of dexmedetomidine and opioid may be an alternative to high-dose opioid in attenuating cough during emergence from anesthesia, while also reducing the adverse effects of high-dose opioid. We tested the hypothesis that a single-dose of dexmedetomidine combined with low-dose remifentanil infusion during emergence would not be inferior to high-dose remifentanil infusion alone in attenuating cough after thyroidectomy. Methods: One hundred sixty-nine patients undergoing thyroidectomy were enrolled and randomized in a 1:1 ratio into group DR or group R. Each patient received an infusion of dexmedetomidine (0.5 µg/kg) and low-dose remifentanil infusion of effect-site concentration (Ce) at 1 ng/mL or normal saline and high-dose remifentanil infusion of Ce at 2 ng/mL for 10 min at the end of surgery. Remifentanil was maintained until tracheal extubation. Primary endpoint was the severity of coughing, which was assessed for non-inferiority using a four-point scale at the time of extubation. For comparison of coughing incidence during emergence, coughing grade was also measured at three times: before extubation, at extubation, and after extubation. Time to awakening, hemodynamic and respiratory profile, pain, and postoperative nausea and vomiting were also evaluated for superiority. Results: The 95% confidence intervals for differences in cough grade during tracheal extubation were <0.9, indicating non-inferiority of the single dose of dexmedetomidine combined with low-dose remifentanil infusion. The incidence of coughing was similar in the two groups. Hemodynamic changes during tracheal extubation were attenuated, but emergence from anesthesia was delayed, in group DR. Use of rescue antiemetic was similar in both groups, but the incidence of vomiting was less in group DR. Conclusion: A single-dose of dexmedetomidine (0.5 µg/kg) combined with low-dose remifentanil infusion at 1 ng/mL of Ce during emergence from sevoflurane-remifentanil anesthesia was not inferior to high-dose remifentanil infusion alone at 2 ng/mL of Ce with regard to suppressing cough.


Asunto(s)
Anestesia General/efectos adversos , Tos/tratamiento farmacológico , Dexmedetomidina/administración & dosificación , Remifentanilo/administración & dosificación , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Anestesia General/métodos , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Remifentanilo/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
16.
Sci Technol Adv Mater ; 20(1): 1118-1130, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-32002086

RESUMEN

(ta-C) films coated through the filtered cathodic vacuum arc (FCVA) process as a hole transport layer (HTL) for perovskite solar cells (PSCs) and quantum dot light-emitting diodes (QDLEDs). The p-type ta-C film has several remarkable features, including ease of fabrication without the need for thermal annealing, reasonable electrical conductivity, optical transmittance, and a high work function. X-ray photoelectron spectroscopy and ultraviolet photoelectron spectroscopy examinations show that the electrical properties (sp3/sp2 hybridized bond) and work function of the ta-C HTL are appropriate for PSCs and QDLEDs. In addition, in order to correlate the performance of the devices, the optical, surface morphological, and structural properties of the FCVA-grown ta-C films with different thicknesses (5 ~ 20 nm) deposited on the ITO anode are investigated in detail. The optimized ta-C film with a thickness of 5 nm deposited on the ITO anode had a sheet resistance of 10.33 Ω-2, a resistivity of 1.34 × 10-4 Ω cm, and an optical transmittance of 88.97%. Compared to the reference PSC with p-NiO HTL, the PSC with 5 nm thick ta-C HTL yielded a higher power conversion efficiency (PCE, 10.53%) due to its improved fill factor. Further, the performance of QDLEDs with 5 nm thick ta-C hole injection layers (HIL) showed better than the performance of QDLEDs with different ta-C thicknesses. It is concluded that ta-C films have the potential to serve as HTL and HIL in next-generation PSCs and QDLEDs.

17.
J Environ Manage ; 244: 304-312, 2019 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-31128335

RESUMEN

The adoption rate for Leadership in Energy and Environmental Design - Neighborhood Development (LEED-ND) projects has varied considerably across the United States. Local governments and developers face variation in the incentives and barriers while implementing LEED-ND projects across four key dimensions - economic, policy, public awareness, and organizational. This paper investigated the drivers of variation using a mixed-methods approach including a two-stage Heckman model, a survey of Texas subdivision developers and interviews with local planning officials. Results indicate that initial public funding may lead to more LEED-ND projects being completed, but with a diminishing return as these projects become established within the region. Support for local programs including tax abatement, public-private partnerships, and other incentives were also demonstrated to help facilitate LEED-ND project adoption. Overall this paper underscored the important role, especially early on, the public sector and local governments play in initiating local LEED-ND projects to inform and motivate the land development industry.


Asunto(s)
Liderazgo , Motivación , Asociación entre el Sector Público-Privado , Características de la Residencia , Texas
18.
Anesth Analg ; 126(4): 1353-1361, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29324496

RESUMEN

BACKGROUND: The optimal regional technique for analgesia and improved quality of recovery after video-assisted thoracic surgery (a procedure associated with considerable postoperative pain) has not been established. The main objective in this study was to compare quality of recovery in patients undergoing serratus plane block (SPB) with either ropivacaine or normal saline on the first postoperative day. Secondary outcomes were analgesic outcomes, including postoperative pain intensity and opioid consumption. METHODS: Ninety patients undergoing video-assisted thoracic surgery were randomized to receive ultrasound-guided SPB with 0.4 mL/kg of either 0.375% ropivacaine (SPB group) or normal saline (control group) after anesthetic induction. The primary outcome was the 40-item Quality of Recovery (QoR-40) score at 24 hours after surgery. The QoR-40 questionnaire was completed by patients the day before surgery and on postoperative days 1 and 2. Pain scores, opioid consumption, and adverse events were assessed for 2 days postoperatively. RESULTS: Eighty-five patients completed the study: 42 in the SPB group and 43 in the control group. The global QoR-40 scores on both postoperative days 1 and 2 were significantly higher in the SPB group than in the control group (estimated mean difference 8.5, 97.5% confidence interval [CI], 2.1-15.0, and P = .003; 8.5, 97.5% CI, 2.0-15.1, and P = .004, respectively). The overall mean difference between the SPB and control groups was 8.5 (95% CI, 3.3-13.8; P = .002). Pain scores at rest and opioid consumption were significantly lower up to 6 hours after surgery in the SPB group than in the control group. Cumulative opioid consumption was significantly lower up to 24 hours postoperatively in the SPB group. CONCLUSIONS: Single-injection SPB with ropivacaine enhanced the quality of recovery for 2 days postoperatively and improved postoperative analgesia during the early postoperative period in patients undergoing video-assisted thoracic surgery.


Asunto(s)
Anestésicos Locales/administración & dosificación , Músculos Intermedios de la Espalda/inervación , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Ropivacaína/administración & dosificación , Cirugía Torácica Asistida por Video , Ultrasonografía Intervencional , Adulto , Anciano , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Recuperación de la Función , República de Corea , Ropivacaína/efectos adversos , Cirugía Torácica Asistida por Video/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
19.
Int J Med Sci ; 15(10): 961-968, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30013436

RESUMEN

Background: The efficacy of dexamethasone plus palonosetron for postoperative nausea and vomiting (PONV) prophylaxis is not firmly established. This randomized, double-blind, controlled study evaluated whether the combination was superior to palonosetron alone in preventing PONV in patients receiving intravenous patient-controlled analgesia (IV-PCA) after upper extremity surgery. Methods: A total of 202 patients undergoing upper extremity surgery were randomly assigned to group P (palonosetron alone) or group PD (palonosetron plus dexamethasone). Group P patients received palonosetron 0.075 mg and normal saline 1.6 mL; group PD patients received palonosetron 0.075 mg and dexamethasone 8 mg. In both groups, palonosetron was added to the IV-PCA opioid infusion, which was continued for 48 h postoperatively. Incidence and severity of nausea, incidence of vomiting, rescue antiemetic requirements, pain intensity, and rescue analgesic requirements were evaluated for 72 h postoperatively. Quality of recovery was assessed using the quality of recovery-15 (QoR-15) questionnaire. Results: The incidence of PONV was significantly lower in group PD than in group P at 0-48 h postoperatively (61.5% vs 77.1%; p = 0.019). Severity of nausea at 0-6 h postoperatively was significantly less in group PD compared with group P (none/mild/moderate/severe: 49/22/15/10 vs. 36/16/25/19, p = 0.008). The incidence of vomiting and rescue antiemetic requirements were similar between groups. Pain intensity was significantly less in group PD than in group P at 0-48 h and 48-72 h postoperatively. Global QoR-15 was similar 24 h postoperatively between groups. Conclusions: Dexamethasone-palonosetron combination therapy reduced PONV incidence and postoperative pain in patients receiving opioid-based analgesia after upper extremity surgery.


Asunto(s)
Analgésicos Opioides/efectos adversos , Antieméticos/administración & dosificación , Dexametasona/administración & dosificación , Náusea/tratamiento farmacológico , Palonosetrón/administración & dosificación , Vómitos/tratamiento farmacológico , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Estudios Prospectivos , Vómitos/inducido químicamente
20.
J Nanosci Nanotechnol ; 18(8): 5721-5725, 2018 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-29458631

RESUMEN

Highly water-dispersible magnetic nanoparticles were synthesized by convenient electrochemical techniques using a continuous flow reactor. The surface properties of the magnetic nanoparticles (MNPs) were modified with hydrophilic organic ligands during the electrochemical synthesis process to control the degree of dispersion in water. The kind of hydrophilic low-molecular weight polymers or surfactants influenced the sizes of the particles ranged between 25-40 nm (in diameter) and their size distribution. Chitosan-modified MNPs exhibited the most uniform particle size distribution among the MNPs synthesized in this study as well as excellent dispersion stability and magnetic properties in water after the crosslinking of the amino groups in chitosan. Especially, the dispersion stability of the MNPs in water was systematically investigated via a light scattering analysis.

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