Inferior Hypogastric Plexus Block Affects Sacral Nerves and the Superior Hypogastric Plexus

Background. The inferior hypogastric plexus mediates pain sensation through the sympathetic chain for the lower abdominal and pelvic viscera and is thought to be a major structure involved in numerous pelvic and perineal pain syndromes and conditions. Objectives. The objective of this study was to demonstrate the structures affected by an inferior hypogastric plexus blockade utilizing the transsacral approach. Study Design. This is an observational study of fresh cadaver subjects. Setting. The cadaver injections and dissections were performed at the Department of Forensic Sciences and Insurance Medicine, Semmelweis University, Budapest, Hungary after obtaining institutional review board approval. Methods. 5 fresh cadavers underwent inferior hypogastric plexus blockade with radiographic contrast and methylene blue dye injection by the transsacral fluoroscopic technique described by Schultz followed by dissection of the pelvic and perineal structures to localize distribution of the indicator dye. Radiographs demonstrating correct needle localization by contrast spread in the specific tissue plane and photographs of the dye distribution after cadaver dissection were recorded for each subject. Results. In all cadavers the dye spread to the posterior surface of the rectum and the superior hypogastric plexus. The dye also demonstrated distribution to the anterior sacral nerve roots of S1, 2, and 3 with bilateral spread in 3 cadavers and ipsilateral spread in 2 of them. Limitations. The small number of cadaver specimens in this study limits the results and generalization of their clinical significance. Conclusions. Inferior hypogastric plexus blockade by a transsacral approach results in distribution of dye to the anterior sacral nerve roots and superior hypogastric plexus as demonstrated by dye spread in freshly dissected cadavers and not by local anesthetic spread to other pelvic and perineal viscera.

BEHIND THE COMPUTER SCREEN: WHAT IRB PROFESSIONALS REALLY THINK ABOUT SOCIAL MEDIA RESEARCH

Thesis (Master's)--University of Washington, 2016-06

Perioperative cerebrospinal fluid and plasma inflammatory markers after orthopedic surgery.

BACKGROUND: Postoperative delirium is prevalent in older patients and associated with worse outcomes. Recent data in animal studies demonstrate increases in inflammatory markers in plasma and cerebrospinal fluid (CSF) even after aseptic surgery, suggesting that inflammation of the central nervous system may be part of the pathogenesis of postoperative cognitive changes. We investigated the hypothesis that neuroinflammation was an important cause for postoperative delirium and cognitive dysfunction after major non-cardiac surgery. METHODS: After Institutional Review Board approval and informed consent, we recruited patients undergoing major knee surgery who received spinal anesthesia and femoral nerve block with intravenous sedation. All patients had an indwelling spinal catheter placed at the time of spinal anesthesia that was left in place for up to 24 h. Plasma and CSF samples were collected preoperatively and at 3, 6, and 18 h postoperatively. Cytokine levels were measured using ELISA and Luminex. Postoperative delirium was determined using the confusion assessment method, and cognitive dysfunction was measured using validated cognitive tests (word list, verbal fluency test, digit symbol test). RESULTS: Ten patients with complete datasets were included. One patient developed postoperative delirium, and six patients developed postoperative cognitive dysfunction. Postoperatively, at different time points, statistically significant changes compared to baseline were present in IL-5, IL-6, I-8, IL-10, monocyte chemotactic protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, IL-6/IL-10, and receptor for advanced glycation end products in plasma and in IFN-γ, IL-6, IL-8, IL-10, MCP-1, MIP-1α, MIP-1β, IL-8/IL-10, and TNF-α in CSF. CONCLUSIONS: Substantial pro- and anti-inflammatory activity in the central neural system after surgery was found. If confirmed by larger studies, persistent changes in cytokine levels may serve as biomarkers for novel clinical trials.

Boards of directors' contribution to strategy : a literature review and research agenda

Research Question/Issue: Over the last four decades, research on the relationship between boards of directors and strategy has proliferated. Yet to date there is little theoretical and empirical agreement regarding the question of how boards of directors contribute to strategy. This review assesses the extant literature by highlighting emerging trends and identifying several avenues for future research. Research Findings/Results: Using a content-analysis of 150 articles published in 23 management journals up to 2007, we describe and analyze how research on boards of directors and strategy has evolved over time. We illustrate how topics, theories, settings, and sources of data interact and influence insights about board–strategy relationships during three specific periods. Theoretical Implications: Our study illustrates that research on boards of directors and strategy evolved from normative and structural approaches to behavioral and cognitive approaches. Our results encourage future studies to examine the impact of institutional and context-specific factors on the (expected) contribution of boards to strategy, and to apply alternative methods to fully capture the impact of board processes and dynamics on strategy making. Practical Implications: The increasing interest in boards of directors’ contribution to strategy echoes a movement towards more strategic involvement of boards of directors. However, best governance practices and the emphasis on board independence and control may hinder the board contribution to the strategic decision making. Our study invites investors and policy-makers to consider the requirements for an effective strategic task when they nominate board members and develop new regulations.

The design and construction of flat rectangular otter boards for bottom trawling: a review

The design and construction of the otter board is a subject of great importance for economy in trawling. This review incorporates a historical resume tracing the change and development• of otter boards. The size of the otter board and its relationship with the horse power of the engine and size of the net and the methods of rigging are dealt with. The factors influencing the horizontal spread are discussed. The effect of the angles of attack, heel and tilt and the ground reaction on the force coefficients have been reviewed and discussed with particular reference to flat rectangular otter boards used for bottom trawling. A short account of other designs of otter boards used for improved efficiency is given. Suggestion for improving the efficacy of otter boards based on the work hitherto done has been made. The contributions relating to the various aspects of design and performance of trawl boards carried out till 1969 have been considered.

Institutional Boundaries and Judicial Review - Some Thoughts on How the Court is Going About Its Business: Desperately Seeking Coherence

Cet article a précédemment été publié par la Supreme Court Law Review (Second Series).

Rethinking ethics review as institutional discourse

In this article, the authors trace the emergence of an institutional discourse of ethical research and interrogate its effects in constituting what ethical research is taken to be and how ethical researchers are configured. They illuminate the dissonance between this regime of truth and research practice and the implications for the injunction to respect others, illustrating their case with instances from their interview study with anorexic teenage girls. The authors propose that conceptualising the regulation of research ethics as an institutional discourse opens up the possibility for asserting counterdiscourses that place relational ethics at the center of moral decision making in research.

Climate change in Switzerland: a review of physical, institutional, and political aspects

Climate change is clearly discernible in observed climate records in Switzerland. It impacts on natural systems, ecosystems, and economic sectors such as agriculture, tourism, and energy, and it affects Swiss livelihood in various ways. The observed and projected changes call for a response from the political system, which in Switzerland is characterized by federalism and direct democratic instruments. Swiss climate science embraces natural and social sciences and builds on institutionalized links between researchers, public, and private stakeholders. In this article, we review the physical, institutional, and political aspects of climate change in Switzerland. We show how the current state of Swiss climate science and policy developed over the past 20 years in the context of international developments and national responses. Specific to Switzerland is its topographic setting with mountain regions and lowlands on both sides of the Alpine ridge, which makes climate change clearly apparent and for some aspects (tourist sector, hydropower, and extreme events) highly relevant and better perceivable (e.g., retreating glaciers). Not surprisingly the Alpine region is of central interest in Swiss climate change studies.

IVHS Institutional and Legal Issues Program. Review of the Travlink and Genesis operational tests. Final report.

Federal Highway Administration, Washington, D.C.

The elementary and complete examiner; or, Candidate's assistant: prepared to aid teachers in securing certificates from boards of examiners, and pupils in preparing themselves for promotion, teachers in selecting review questions in normal schools, institutes, and in all drill and class exercises.

Mode of access: Internet.