Tigard-Tualatin School District

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Background:Total knee Arthroplasty(TKA) surgery is a major surgical procedure that requires effective and safe anaesthesia. Spinal anaesthesia is most widely used technique for total knee arthroplasty surgeries. Choice of local anaesthetics depends mainly onset, duration, intensity of sensory and motor block and side effects. Aim: To study and compare the efcacy and safety of 0.5% Levobupivacaine with 0.5% Bupivacaine in spinal anaesthesia on patients undergoing total knee replacement surgery . Design: Randomised Controlled study. Material & Methods: The study includes 40 patients randomly divided into 2 groups of 20 each. Group A patients received 3ml of 0.5% Levobupivacaine (15mg) 5mg/ml with 15 mcg of fentanyl.Group B patients received 3ml of 0.5% Bupivacaine (15mg) 5mg/ml with 15 mcg of fentanyl. Statistical Analysis: by using SPSS version 20 (Statistical Package for Social Studies), Chi square test, F table, Mean and standard deviation were used. Results & Conclusion: Duration of sensory block and time for rst requirement of post-operative analgesia was longer in patients who received 0.5% Levobupivacaine intrathecally when compared to 0.5% Bupivacaine intrathecally. Though there was no statistical signicance in terms of onset of sensory block, there was a slow onset of motor block and less duration of motor block seen in Levobupivacaine group. Stable haemodynamics were observed with Levobupicaine. Hence, Levobupivacaine is a better alternative to Bupivacaine.

Objectives: Geospatial “smart” technology such as PulsePoint is increasingly used to crowdsource community response for suspected out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification is imperfect such that activation often occurs for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well characterized. Methods: Prospective 3-year cohort investigation of patients for whom the PulsePoint was activated for suspected OHCA in four United States communities (total population ~1 million). We evaluated those patients with a PulsePoint activation for suspected OHCA who were subsequently not found to be in cardiac arrest on arrival. The response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) as well as laypersons who were only notified to public locations. We linked the PulsePoint information with EMS records to report the frequency, condition type, and EMS treatment for these patients. Results: Of 1779 calls where volunteers were activated, 756 were OHCA, which left 1023 non-arrest patients for evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). These findings were similar for private and public locations. The most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG (27.9%, n=285), naloxone administration (9.8%, n=100), and airway or ventilation assistance (8.7%, n=89). Conclusions: More than half of patients activated for suspected OHCA by PulsePoint in both public and private had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care provided by both layperson and public safety volunteers if they were appropriately trained and equipped.

Outside Front Cover: Photograph of the face of a vacuum ultraviolet (VUV)-emitting lamp reflected by a 15 cm (6”) diameter silicon wafer. Having a radiating area of 100 cm2, the lamp is the optical source for a commercial VUV photolithography system, manufactured by Cygnus Photonics, with which polymers serve as a dry photoresist. Its peak emission wavelength of 172 nm allows for photopatterning of polymers and cellulose with 10 nm depth precision. Further details can be found in the article by Jinhong Kim, Andrey E. Mironov, Jin H. Cho, Dane S. Sievers, Cyrus M. Herring, Sehyun Park, Peter P. Sun, Zhihu Liang, Wenyuan Chen, Sung-Jin Park, and J. Gary Eden (e2200075)

Purpose:To report efficacy and safety of samotolisib (LY3023414; PI3K/mTOR dual kinase and DNA-dependent protein kinase inhibitor) plus enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) following cancer progression on abiraterone.Patients and Methods:In this double-blind, placebo-controlled phase Ib/II study (NCT02407054), following a lead-in segment for evaluating safety and pharmacokinetics of samotolisib and enzalutamide combination, patients with advanced castration-resistant prostate cancer with progression on prior abiraterone were randomized to receive enzalutamide (160 mg daily)/samotolisib (200 mg twice daily) or placebo. Primary endpoint was progression-free survival (PFS) assessed by Prostate Cancer Clinical Trials Working Group criteria (PCWG2). Secondary and exploratory endpoints included radiographic PFS (rPFS) and biomarkers, respectively. Log-rank tests assessed treatment group differences.Results:Overall, 13 and 129 patients were enrolled in phase Ib and II, respectively. Dose-limiting toxicity was not reported in patients during phase Ib and mean samotolisib exposures remained in the targeted range despite a 35% decrease when administered with enzalutamide. In phase II, median PCWG2-PFS and rPFS was significantly longer in the samotolisib/enzalutamide versus placebo/enzalutamide arm (3.8 vs. 2.8 months; P = 0.003 and 10.2 vs. 5.5 months; P = 0.03), respectively. Patients without androgen receptor splice variant 7 showed a significant and clinically meaningful rPFS benefit in the samotolisib/enzalutamide versus placebo/enzalutamide arm (13.2 months vs. 5.3 months; P = 0.03).Conclusions:Samotolisib/enzalutamide has tolerable side effects and significantly improved PFS in patients with mCRPC with cancer progression on abiraterone, and this may be enriched in patients with PTEN intact and no androgen receptor splice variant 7.

A large water supply pipeline has been designed to carry water from the Willamette River in Gladstone, OR to the cities of Lake Oswego and Tigard, Oregon. The pipeline ranges in diameter from 24 to 48 inches and traverses more than 10 miles. The pipeline was part of an overall water supply project that included a raw water intake, a raw water pipeline, a water treatment plant, a finished water pipeline, and a reservoir. Finding a route for the pipeline was challenging as it traversed through many cities, and required a number of interagency agreements. Along with the routing challenges, there were many technical challenges such as crossing beneath the Willamette River. This crossing is 36-inches in diameter through basalt that varies in unconfined compressive strength, which exceeds 40,000 psi. An extensive trenchless evaluation was performed to determine the method that offered the highest chance of success with the lowest overall risk profile. Horizontal directional drilling (HDD) was chosen as the preferred trenchless installation technique. The length of the river crossing is 3,800 feet, making the 36inch diameter rock drill very challenging. In addition to the challenges of the drill, site and pipe layout was very restricted, further complicating and increasing the risk of the project.. Many aspects of the drill had to be thoroughly laid out during design, leaving little flexibility to the contractor.

Abstract We investigated gender differences of children and adolescents on positive social and emotional competencies using a new strength‐based measure of positive social–emotional attributes and resilience—the Social–Emotional Assets and Resilience Scales (SEARS) cross‐informant system. Caregivers, teachers, and students in grades kindergarten through 12 from schools across several U.S. states completed SEARS rating scales and self‐report forms. Females were consistently rated as having significantly higher total scores on all versions of the SEARS assessment system (p < .01), indicating consistent perceptions of females' higher levels of social–emotional competencies by all raters. These differences were not impacted by the grade students were in or the gender of the parent or teacher rater. Implications of these findings and future directions are discussed. © 2011 Wiley Periodicals, Inc.

This paper describes the performance tests for variable speed drive systems. Most of the applications for VSD systems involved in variable torque loads such as fans and centrifugal pumps, where the load power varies as the cube of the speed. The performance tests of VSD systems are planned to measure efficiency of the VSD unit and the efficiency of the involved motor. The real benefit of VSD systems is the reduction of energy used to provide the quantity of end product of the pumps or fans. The result of these tests were tabulated and consolidated in the paper. Each manufacturer received a copy of reports on their own motors.