Civic bibliography for Greater New York,

"The original work was done by Messrs. Howard B. Woolston, PH.D., and Roger Howson...Their work was subsequently added to and completed by Miss Catharine S. Tracey."- Pref.

Greater West Park system. West Chicago Park Commission; [Chicago, Illinois]

Green, red and black ink on linen. Map of Chicago with parks, boulevards, municipal kitchen gardens. Signed. 132 cm. x 95 cm. Scale: 1"=1500' [from photographic copy by Lance Burgharrdt]

A Greater West Park System, April 1919 (CHI-Parks 16)

original file name DSC_0004

A new key to the exact sciences, or, A new and practical theory by which mathematical problems or algebraic equations of almost every description can be solved with accuracy : and with greater facility and simplicity than they can be by any method that has yet been given by any other author : in which are also introduced, a variety of useful and interesting problems, that have never before been proposed, and which it is believed cannot be solved by any methods or rules except those here laid down /

Mode of access: Internet.

Transportation in Lansing prior to 1905; paper read before the Historical Society of Greater Lansing, April 2, 1959.

Includes bibliography.

The greater patriotism; public addresses,

Mode of access: Internet.

Greater Salem in the Spanish-American War /

Mode of access: Internet.

Directions for class work in practical physiology, elementary physiology of muscle and nerve and of the vascular and nervous systems,

Mode of access: Internet.

Problems of Greater Britain,

Mode of access: Internet.

Year book of the Medical Association of the Greater City of New York.

Description based on: June 1907.

Managing inspections for greater productivity.

Winter 1977.

Greater dead than alive.

Bibliography: p. 241-242.

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.

Comparison of Analgesic Outcomes Following Sciatic Nerve Blockade Performed by Resident Trainees and Nurse Anesthetists

Background and objectives: Peripheral nerve blockade requires regional anesthesia skills that are taught in several formats and assessing technical proficiency has shifted from fulfillment of quotas to comprehensive procedural evaluation. Complete analgesia is the clinical endpoint validating successful nerve blockade but patient, technical and procedural factors influence this result. The purpose of this study was to determine if physician trainee or nurse anesthetist administered sciatic nerve blockade influence postoperative pain scores and opioid analgesic requirements and if patient factors, technique and repetition influence this outcome. Method: Sciatic nerve blockade by nerve stimulation and ultrasound based techniques were performed by senior anesthesiology resident trainees and nurse anesthetists under the supervision of regional anesthesia faculty. Preoperative patient characteristics including obesity, trauma, chronic pain, opioid use and preoperative pain scores were recorded and compared to the post-procedure pain scores and opioid analgesic requirements upon discharge from the post-anesthesia care unit and 24 hours following sciatic nerve blockade. Results: 93 patients received sciatic nerve blockade from 22 nurse anesthetists and 21 residents during 36 months. A significant relation between training background and improved pain scores was not demonstrated but transition from nerve stimulation to ultrasound guided techniques lowered immediate opioid usage in all groups. Patients with pre-existing chronic opioid use had higher postoperative pain scores and opioid dosages following nerve block. Conclusion: Patient analgesia should be an integral measure of proficiency in regional anesthesia techniques and evaluating this procedure outcome for all practitioners throughout their training and beyond graduation will longitudinally assess technical expertise.