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Edward R. Mariano,Seshadri C. Mudumbai,Toni Ganaway,T. Edward Kim,Steven K. Howard,Nicholas J. Giori,Cynthia Shum 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.1
Background: Adductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients’ physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation. Methods: We conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status. Results: Data from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th–90th percentiles]) compared to femoral patients (0 [0–5] vs. 4 [0–10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = −2.6; 95% CI: −4.5, −0.8, P = 0.01) with R2 = 0.1. Conclusions: Adductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.
NATIONAL SOCIALISM AND EDUCATION IN GERMANY, 1933-45
BEAUCHAMP, EDWARD R. 이화여자대학교 동서교육연구소 1983 East west education Vol.4 No.2
In describing education in Germany during the Nazi period, R. Freeman Butts concludes that "The Nazis perhaps went further in complete control of schools for political purposes than any other nation up to that time. They showed the world what a power education could be in achieving political and social ends."1) The Nazis also probably went futher than any previous regime in using youth organizations and other non-school "educational" approaches in spreading their political and social views. Whether National Socialist education was merely a reflection of the political forces of the time, or whether education actually helped in the creation and shaping of these forces is a question which goes beyond the scope of this paper. Its purpose is simply to trace the influence of National Socialism on education from its philosophical origins to its implementation in schools and other educational agencies. George Kneller, an early student of Nazi education thought, suggests that the history of German educational philosophy is "noteworthy for the fact that it has progressed for the most part along nationalistic lines."2) George Mosse explains this assertion by the political development of Germany with its prolonged and unsuccessful attempts to achieve national unity. Extreme want and the degradation of national pride under Napoleon had created intense feelings of patriotism among many Germans. These feelings were reflected in the thinking of German philosophers and poets, whose previously international leanings now turned toward national interests. Schiller, Fichte, Hegel and Nietzsche are but a few of the names that come readily to mind in this regard.
A comparison of strength for two continuous peripheral nerve block catheter dressings
Edward R. Mariano,Lindsay Borg,Steven K. Howard,T. Edward Kim,Lauren Steffel,Cynthia Shum 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.5
Background: Despite the benefits of continuous peripheral nerve blocks, catheter dislodgment remains a major problem, especially in the ambulatory setting. However, catheter dressing techniques to prevent such dislodgment have not been studied rigorously. We designed this simulation study to test the strength of two commercially available catheter dressings. Methods: Using a cadaver model, we randomly assigned 20 trials to one of two dressing techniques applied to the lateral thigh: 1) clear adhesive dressing alone, or 2) clear adhesive dressing with an anchoring device. Using a digital luggage scale attached to a loop secured by the dressing, the same investigator applied steadily increasing force with a downward trajectory towards the floor until the dressing was removed or otherwise disrupted. Results: The weight, measured (median [10th–90th percentile]) at the time of dressing disruption or removal, was 1.5 kg (1.3–1.8 kg) with no anchoring device versus 4.9 kg (3.7–6.5 kg) when the dressing included an anchoring device (P < 0.001). Conclusions: Based on this simulation study, using an anchoring device may help prevent perineural catheter dislodgement and therefore premature disruption of continuous nerve block analgesia.