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Prolonged Opioid-Sparing Pain Control after Hemorrhoidectomy with Liposome Bupivacaine: Results from a Cohort of 95 Patients

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Pain Studies and Treatment 2016年第1期4卷 5-12页

作者： Allen B. Jetmore douglas hagen Department of Surgery Overland Park Surgery Center Overland Park KS USA Shawnee Mission Medical Center Shawnee Mission KS USA Department of Anesthesia Anesthesia Associates of Kansas City Overland Park KS USA

The objective of this retrospective study was to examine the effects of an intraoperative injection of liposome bupivacaine on the quality and duration of postsurgical pain control, patient satisfaction, and opioid use in a cohort of patients undergoing hemorrhoidectomy in an outpatient setting. Patients underwent ambulatory hemorrhoidectomy conducted by a single surgeon. Liposome bupivacaine 266 mg/20 mL was administered via infiltration at the end of surgery. After discharge, pain-related outcomes were assessed via telephone interviews. Outcomes of interest included first onset of pain after surgery, patient-reported pain intensity (0 = no pain;10 = worst pain imaginable), time to first use of orally administered opioids after surgery, number of opioid tablets consumed postsurgery, and patient’s satisfaction with postsurgical pain control. A total of 95 patients were included;the average number of hemorrhoids excised was 3.0 (median, 2.7) per patient. Mean time to first onset of pain after surgery was 36 hours;mean time to first consumption of postsurgical opioids was 38 hours. Mean pain intensity scores remained <5 through 72 hours after surgery. The average number of opioid analgesic tablets consumed after surgery was 12.4;13% (12/95) of patients required no postsurgical opioids. Seventy-five percent of patients reported being “very satisfied” or “perfectly satisfied” with their overall pain control. No liposome bupivacaine-related adverse events were observed. A single intraoperative injection of liposome bupivacaine safely facilitated ambulatory hemorrhoidectomy, eliminated the need for intravenous opioids, minimized opioid use, and was associated with high levels of patient satisfaction.

关键词： Postoperative Pain Hemorrhoidectomy Liposome Bupivacaine Postoperative Analgesia

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Remarks on Almost Everywhere Convergence and Approximate Identities

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Acta Mathematica Sinica,English Series 2025年第1期41卷 255-272页

作者： Sean douglas Loukas Grafakos Department of Mathematics University of MissouriColumbia MO 65211USA

We prove almost everywhere convergence for convolutions of locally integrable functions with shrinking L^(1) dilations of a fixed integrable kernel with an integrable radially decreasing *** set on which the convergence holds is an explicit subset of the Lebesgue set of the locally integrable function of full *** result can be viewed as an extension of the Lebesgue differentiation theorem in which the characteristic function of the unit ball is replaced by a more general *** obtain a similar result for multilinear convolutions.

关键词： Almost everywhere convergence approximate identities Lebesgue set

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The Prevalence, Patterns, and Trend of Antimicrobial Resistance among Patients at Kumi Orthopaedic Center: A Retrospective Study

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Open Journal of Orthopedics 2025年第1期15卷 22-30页

作者： John Ekure Naomi Amuron douglas Kilama Phillip Buluma Andrew Iloket Emmanuel Okiring Samuel Okodi Faith Akello Kumi Orthopaedic Center Kumi Uganda College of Health Sciences Soroti University Soroti Uganda

Background: Antimicrobial Resistance (AMR) has been recognized as a global public health problem of utmost importance that needs to be tackled. Low-income countries such as Uganda have the greatest burden of severe and life-threatening infections and are most likely to suffer more from the spread of untreatable resistant bacteria. Despite the generally increasing trends in AMR, there is hardly any documented data on AMR in orthopedic care. Methods: We analyzed data from the pathogenic isolates from pus and tissue from the laboratory from 2019 to 2023. We calculated the proportions of isolates resistant to commonly used antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR across the study period. Results: Out of the 286 isolates, 104 (43.5%) were from pus, 112 (46.9%) were from tissue samples and the remaining 9.6% were from different fluid aspirates like synovial fluid. Most of the isolates were from males (64.2%) and aged between 19 and 45 years (46.2%). The distribution of whether the bacteria were gram-positive or negative was relatively equal with 114 (45.2%) being gram-negative and 120 (47.6%) gram-positive. Generally, there was increased AMR across all antibiotics from 2019 to 2021 e.g. for Imipinem, it went from 0% in 2019 to 70.8% in 2021 and for Amoxyclav, it went from 10% in 2019 to 93.2% in 2021. There was a general decline in AMR noted from 2021 to 2023. However, currently, the highest resistance is noted in ceftriaxone (80.0%) and the lowest in Imipinem (11.76%). Conclusion: There is a general decreasing trend in AMR, most probably due to increasing policies governing the use of antibiotics. However, there is still high resistance to commonly used and affordable antibiotics. Continuous monitoring of AMR is still recommended to reduce the AMR problem in Uganda at large through public health policy and planning.

关键词： Antimicrobial Resistance Prevalence Trend

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Forests,atmospheric water and an uncertain future: the new biology of the global water cycle

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Forest Ecosystems 2018年第3期5卷 236-257页

作者： douglas Sheil Faculty of Environmental Sciences and Natural Resource Management(MINA) Norwegian University of Life Sciences (NMBU)

Theory and evidence indicate that trees and other vegetation influence the atmospheric water-cycle in various *** influences are more important, more complex, and more poorly characterised than is widely *** there is little doubt that changes in tree cover will impact the water-cycle, the wider consequences remain difficult to predict as the underlying relationships and processes remain poorly characterised. Nonetheless, as forests are vulnerable to human activities, these linked aspects of the water-cycle are also at risk and the potential consequences of large scale forest loss are severe. Here, for non-specialist readers, I review our knowledge of the links between vegetation-cover and climate with a focus on forests and rain(precipitation). I highlight advances, uncertainties and research opportunities. There are significant shortcomings in our understanding of the atmospheric hydrological cycle and of its representation in climate models. A better understanding of the role of vegetation and tree-cover wil reduce some of these shortcomings. I outline and il ustrate various research themes where these advances may be *** themes include the biology of evaporation, aerosols and atmospheric motion, as well as the processes that determine monsoons and diurnal precipitation cycles. A novel theory—the ‘biotic pump’—suggests that evaporation and condensation can exert a major influence over atmospheric dynamics. This theory explains how high rainfall can be maintained within those continental land-masses that are sufficiently forested. Feedbacks within many of these processes can result in non-linear behaviours and the potential for dramatic changes as a result of forest loss(or gain): for example, switching from a wet to a dry local climate(or visa-versa). Much remains unknown and multiple research disciplines are needed to address this: forest scientists and other biologists have a major role to *** ideas, methods and data offer opportun

关键词： Biotic pump Climate Condensation Evaporation Ice-nucleation Transpiration GCM Vapour Water-cycle

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Materials and technology of Chinese jades dating to the Western Zhou period (1050―771 BCE)

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Science China(Technological Sciences) 2008年第4期51卷 467-480页

作者： Janet G douglas Department of Conservation and Scientific Research Freer Gallery of Art / Arthur M. Sackler Gallery Smithsonian Institution

Excavated jades dating to the Western Zhou period (1050―771 BCE) from the Xi’an area in Shaanxi Province, China, and contemporaneous jades in the collections of the Arthur M. Sackler Gallery at the Smithsonian Institution have been studied to learn about the jade and stone materials and how they were worked during the Western Zhou period. Materials identification was carried out using a combination of techniques such as Fourier-transform infrared spectroscopy and X-ray diffraction. Tool marks were studied using stereomicroscopy and examination of mold impressions using scanning electron microscopy. All of these objects were pro- duced through simple processes involving solid drilling, riffling, and sharp point abrasion; and no evidence was found for the use of rotary tools for incising or sawing.

关键词： jade nephrite stone China Western Zhou scanning electron microscopy materials technology tool marks

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Interpreting forest diversity-productivity relationships:volume values,disturbance histories and alternative inferences

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Forest Ecosystems 2020年第1期7卷 64-75页

作者： douglas Sheil Frans Bongers Faculty of Environmental Sciences and Natural Resource Management(MINA) Norwegian University of Life Sciences(NMBU)Box 50031432 AsNorway Forest Ecology and Forest Management Group Wageningen University&ResearchPO Box 476700 AA WageningenThe Netherlands

Understanding the relationship between stand-level tree diversity and productivity has the potential to inform the science and management of *** shows that plant diversity-productivity relationships are challenging to interpret—and this remains true for the study of forests using non-experimental field *** we highlight pitfalls regarding the analyses and interpretation of such *** examine three themes:1)the nature and measurement of ecological productivity and related values;2)the role of stand history and disturbance in explaining forest characteristics;and 3)the interpretation of any *** show that volume production and true productivity are distinct,and neither is a demonstrated proxy for economic *** stand characteristics,including diversity,volume growth and productivity,vary intrinsically with succession and stand *** should be characterising these relationships rather than ignoring or eliminating *** to do so may lead to misleading *** illustrate,we examine the study which prompted our concerns—Liang et al.(Science 354:aaf8957,2016)—which developed a sophisticated global analysis to infer a worldwide positive effect of biodiversity(tree species richness)on“forest productivity”(stand level wood volume production).Existing data should be able to address many of our *** evaluations will improve understanding.

关键词： Causation Correlation Diversity Inference Productivity Richness Tree-growth Wood-density

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The Effect of Natural Hazard Damage on Manufacturing Value Added and the Impact of Spatiotemporal Data Variations on the Results

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International Journal of Disaster Risk Science 2022年第5期13卷 691-704页

作者： douglas Thomas Jennifer Helgeson National Institute of Standards and Technology GaithersburgMD 20899USA

This study examined the effect of natural hazards on manufacturing industry value added and the sensitivity of the results from changes to spatiotemporal resolution of the *** measured the negative effects of hazards,rather than the net *** models were developed with varying spatio temporal units for the continental United States:annual/county units;annual/state units;and quarterly/state *** simulations were run using each model to estimate the negative effect of damage from all natural hazards on value added across spatiotemporal ***,an investment analysis was conducted to examine the return from public investments in hazard *** results do not demonstrate that,locally,natural hazards reduce value ***,the evidence suggests that natural hazards in the upstream supply chain have statistically significant impact when modeled at the annual/county scale and at the quarterly/state *** local nor supply chain hazards have a statistically significant effect when modeled at the annual/state scale,suggesting that broader spatiotemporal units may obscure the true downstream effects of natural *** investment analysis,utilizing model results,suggests that an investment of USD 100 billion or less is economical if it results in a reduction in losses of 10% or more.

关键词： Manufacturing Natural hazards Spatiotemporal impacts United States Value added

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Slab and Level 2 Automation Design Guidelines for Optimum Metallurgy and Productivity for Plate and Steckel Mills

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Journal of Iron and Steel Research International 2011年第S1期18卷 550-556页

作者： Stalheim douglas DGS Metallurgical Solutions Inc. 15003 NE 10th StreetVancouverWA 98684 USA

Many new steel plate processing facilities have been built in the past 10 years around the world with many more being planned for the *** is especially true in developing countries such as China,India and *** of these facilities are plate mills with either one or two stands or a Steckel mill,typically only one stand designed for the production of structural plate ***,there is a lack of understanding with both the mill builders of the world and the mill owners on the importance of properly matching up the available slab supply (either new as part of a new plate/Steckel mill complex or part of an already existing) with the desired end plate product *** mill builders and owners around the world believe that you can take any slab of any dimension and make any plate dimension you *** this is basically true with today’s Level 2 automation systems,it does not always result in optimum metallurgy/mechanical properties or *** less than optimum condition results in mechanical property failures,shape issues,productivity losses and in general a less than desirable costly processing *** is important to the overall optimization of a steel processing facility that the proper slab dimensions be used to produce the proper final plate dimensions along with achieving the required mechanical *** critical nature of this selection will be dependent on the final plate thickness and overall mechanical property *** mechanical property,shape and overall microstructure are heavily dependent on the ability to properly work the entire cross section of the slab through the rolling *** mechanical property,shape and microstructural issues are a result of improper working of the entire cross section during *** ability for a given mill to properly work the entire cross section is dependent on proper slab selection (total reduction ratio) and a proper rolling schedule either generated manual

关键词： slab dimensions optimization grain size rolling schedule automation Level 2

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Metallurgical Optimization of Microalloyed Steels for Oil and Gas Transmission Pipelines

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Journal of Iron and Steel Research International 2011年第S1期18卷 669-674页

作者： Stalheim douglas DGS Metallurgical Solutions Inc. 15003 NE 10th StreetVancouverWA98684 USA

The production of microalloyed steels for oil and gas transmission pipelines has increased significantly over the past *** more and more countries developing their own capabilities to produce pipeline steels to support their own internal pipeline infrastructure development,there has been an increase of steel producers working to develop their own capabilities to produce microalloyed steels for this ***,to achieve the desired mechanical property attributes for transmission pipeline applications utilizing a cost effective approach requires metallurgical optimization of the microalloyed *** achieve metallurgical optimization a basic understanding is required in the design of a cost effective alloy and then the proper processing of that alloy design to achieve the optimum microstructure/mechanical *** this sense,many producers in the world,especially those who have only recently,in the past 10 years,developed their capability to produce microalloyed transmission pipeline steels still do not achieve metallurgical optimization of their alloy and *** results in yield losses due to failures,inefficient processing causing productivity losses and additional expensive additions of alloys to compensate for failures and process *** the supplier of plate/coil has the largest percentage effect on the final cost of the pipe,the steel producer must understand proper alloy,microstructure,and process design to produce a uniform and stable plate/coil to be used in pipe *** means that strength,toughness and microstructure must be uniform down the length,across the width and through the cross *** optimization is achieved when this uniformity is achieved with a cost effective *** to that,non-uniformity results in pipe forming,welding,expansion,mechanical property and production issues resulting in downgraded pipe and cost overruns in *** paper will describe targets for p

关键词： microalloy niobium pipeline solubility grain size rolling schedule

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50 years change in urban land use and ecological planning globally in the era of design with nature

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Ecosystem Health and Sustainability 2019年第1期5卷 185-198,I0001页

作者： Ian douglas School of Environment Education and DevelopmentUniversity of ManchesterManchesterUK

Ian McHarg’s 1969 book,Design with Nature,was grounded in earlier good practice,especially the European vision of fitting cities into the regional landscape and carrying thorough surveys before planning *** book emerged in the wake of publications that worried about the ability of the earth to support expanding populations and their growing impact on the *** argued that ecological design should follow planning based on detailed site *** McHarg advised many urban authorities in the USA and other countries,especially in Africa,Asia and Europe,and his ideas had influenced some British new towns,they had little attention in the planning of Milton Keynes,England’s largest new urban settlement,where the initial geological surveys were inadequate,but a successful large tree-planting programhas created a“city in the forest.”McHarg was however closely involved in planning the Nigerian Capital city,Abuja,but his sound master plan was ill-equipped to provide for a nation undergoing post-conflict rebuilding and a local population more concerned with access to land than ecological ***,McHarg helped us to promote,protect,and preserve urban green *** teams from different disciplines now work well together,the integrated thinking advocated by McHarg remains sometimes in short supply in local practice.

关键词： Planning design urban nature garden city site investigation

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