Ultrasound Mapping of Stimulated Finger Flexion During Infra-Clavicular Brachial Plexus Nerve Blockade for Elbow Arthroplasty and Its Correlation To Postoperative Analgesia

Background: Infraclavicular brachial plexus nerve blockade (ICNB) is a very common anesthetic procedure performed for upper extremity surgery at the elbow and distally, however the rate of adequate analgesia is variable among patients. Ultrasound guidance (US) has not been demonstrated to increase the success rate of ICNB when compared to nerve stimulator (NS) guidance. Combined US and NS guided ICNB have not been reported, although there is a call for more trials comparing the two techniques. This study was performed to observe if a specific anatomic region near the axillary artery of the brachial plexus identified by finger flexion with nerve stimulation results in improved postoperative analgesia. Method: Patients undergoing elective elbow arthroplasty received a postoperative ICNB. The angle of the nerve stimulator needle tip and the radial distance from the center of the arterial lumen at which an optimal finger flexion twitch response was observed were measured with ultrasound imaging. Pain scores and postoperative opioid dosages on discharge from the post anesthesia care unit and at 24 hours after surgery were recorded. Results: 11 patients enrolled in this study. Adequate finger flexion response to nerve stimulation that resulted in complete analgesia was more frequently observed when the needle was located in the postero-superior quadrant in relation to the axillary artery. Identifying a specific point near the brachial plexus in relation to the artery that consistently provides superior analgesia is desirable and would lead to improved analgesia and faster onset time of nerve blockade and would reduce the need for other approaches for brachial plexus blockade with their associated disadvantages.

An investigation of contaminant distribution in subsurface marine wood waste at Mill-A South Terminal, Port of Everett, Washington

This project investigates the correlation between contaminants and the wood waste present in marine sediments off the shore of the Port of Everett in the former Weyerhaeuser Mill-A pulp mill site. The investigation includes the results of two field studies, which tested contaminant levels in 22 boreholes as well as several surface samples. The contaminants include heavy metals and wood waste byproducts. These results, along with 14 other bore logs, provide the framework for a three-dimensional site model, interpolating the full extent of the depositional units and organic and inorganic chemicals found at Mill-A. The sediments of interest are divided into five depositional units defined by the percent wood content and type of wood: native material (<5% wood), intermediate (<30% wood), sawdust (<30% wood), woodchips (<30% wood), and poorly sorted sands with silt (SM-SP) (0% wood). The contaminants include arsenic, 2,4-dimethylphenol, and total organic carbon. Three-dimensional modeling software, RockWorks, interpolated the discrete borehole data of sediment and contaminants assuming horizontal continuity between sampling locations. The sediment distribution was calculated within concentration ranges for each contaminant of concern. The lowest detection limits, the screening levels, and the cleanup levels defined these ranges. Total organic carbon served as a proxy to estimate the quantity of wood waste in the sediment. As a known byproduct of wood decomposition, 2,4-dimethylphenol was expected to be more prevalent in the depositional units with more wood waste. Finally, arsenic was a proxy for other contaminants to determine if contaminants at Mill-A are dominant in sediments with high percentages of wood waste. The volumetric distribution established that high levels of total organic carbon are present in the sediment with higher percentages of wood waste. This correlation was stronger in the decomposing sawdust-rich sediment than the woodchip-rich sediment. The 2,4-dimethylphenol concentrations above cleanup standards were dominant in the sawdust-rich, intermediate and native sediments. Concentrations of 2,4-dimethylphenol below cleanup levels characterized the native sediment. The distribution of arsenic showed no statistically significant correlation to wood content in sediment. These results do not support the hypothesis of contaminant-rich wood waste, as many of the high concentrations of contaminants were not in the wood-rich sediments. This suggests that the contaminants are more distributed among all depositional units at Mill-A rather than focused within sediments with a high percent of wood waste. Understanding the distribution of potentially toxic compounds with wood waste is important for restoring the Puget Sound waterways to a more habitable environment. Future studies should include new data to validate these results and to limit the uncertainty of the extent of contaminants. Future studies may also find motive in looking for a correlation between contaminants and grain size based on previous studies linking these characteristics. These investigations will benefit the current cleanup effort as well as future cleanup efforts at similarly contaminated waterways.

Investigating the Effect of Histone H4 Sumoylation on Chromatin Structure and Function

Thesis (Ph.D.)--University of Washington, 2016-06