Traveling wave etched facet waveguide modulators are designed and fabricated. Measurements demonstrate a 56 GHz bandwidth at 1275 nm with power handling greater than 20 dBm. Micro transfer printing onto silicon has also been demonstrated.

Presents information on the IMS 2020 Conference.

Patients with severe aortic stenosis represent a serious perioperative challenge for anesthesiologists when presenting for orthopedic surgery. Avoiding general anesthesia can be beneficial by averting the dramatic hemodynamic changes that can occur at induction and emergence. However, regional anesthesia can similarly produce significant alterations in sympathetic tone in blocked regions. We discuss the successful use of a continuous spinal anesthetic in a patient with severe aortic stenosis undergoing elective total knee arthroplasty.

Background: Adductor canal blocks (ACBs) are an alternative to femoral nerve blocks that minimize lower extremity weakness. However, it is unclear whether this block will provide analgesia that is equivalent to techniques, such as epidural analgesia. The purpose of this randomized controlled trial was to compare continuous ACBs with epidural analgesia for primary total knee arthroplasty. Methods: Following institutional review board approval, 145 patients were randomized to 1 of 3 groups: combined spinal-epidural (CSE), spinal + continuous ACB (CACB), or general + CACB. Epidural analgesia was used postoperatively in the CSE group, and an adductor canal catheter was used in the CACB groups. Power analysis determined that 84 patients per group were needed to demonstrate a 35% increase in ambulation with an alpha of 0.05 at a power of 90%. Results: At interim analysis, 13 patients were removed for protocol deviations, leaving 45 in CSE, 41 in spinal + CACB and 46 in general + CACB groups. Patient demographics were similar in all comparisons suggesting appropriate randomization. Patients in the CACB groups walked further on postoperative day 1, 2, and 3 (P = .02). Mean daily pain scores were lower in the CACB groups (4.1 CSE, 3.0 spinal + CACB, 3.4 general thorn CACB, P = .009). Therewas no significant difference in total opioid consumption between groups (158 morphine equivalents CSE, 149 spinal + CACB, and 172 general + CACB). More patients reported being "very satisfied" in CACB groups (68% general + CACB, 63% spinal + CACB, and 36% CSE; P = .001). Conclusion: Continuous adductor analgesia provides superior ambulation, lower pain scores, faster discharge, and greater patient satisfaction when compared to epidural analgesia for primary total knee arthroplasty. (c) 2017 Elsevier Inc. All rights reserved.

Highly-scaled Indium Phosphide (InP) transistor technologies have bandwidths extending into the terahertz (THz) frequency regime (0.3-3 THz). The high transistor bandwidth can be exploited to both extend circuit operation to THz frequencies and improve system performance at millimeter wave and sub-millimeter wave frequencies. InP heterojunction bipolar transistor (HBT) technologies offer wide bandwidths, high RF power handling and the capability to realize high levels of integration. We review integrated circuit (IC) results from Teledyne's InP HBT technologies that span frequencies from 60 GHz to >600 GHz focusing on performance benefits and applications.

project, a Duke University institutional review board checklist was used to determine that institutional review board approvalwas not required. The project consisted of reviewing deidentified follow-up data on 170 patients discharged with a PNC from the Duke Ambulatory Surgery Center in Durham, North Carolina, from July 2016 to October 2016 prior to this intervention (control group) and 276 patients discharged with a PNC from November 2016 to February 2017 after all faculty and fellows began applying cyanoacrylate to the clamp connector (intervention group). Data demonstrated 8 clamp connector disconnections (4.7%) prior to our intervention and 1 clamp connector disconnection after the intervention (0.4%). Based on these encouraging findings, we believe this may be a way to minimize clamp connector disconnections. There have been no reports of catheter occlusions from applying this adhesive. At Duke, cyanoacrylate is routinely used at the catheter insertion site on the skin in an effort to reduce leakage. Upon initiation of this quality improvement project, cyanoacrylate was additionally applied to the Tuohy-Borst clamp connector from the same adhesive stick at no additional cost. A decrease in disconnections by greater than 90%with this intervention is clinically beneficial in that each year Duke averages more than 4000 PNC placements that are sent home with patients. Given the initial success with this intervention, further investigation seems warranted. In the meantime, we will continue to apply cyanoacrylate glue to the TuohyBorst clamp connectors because it has

A 130 nm InP HBT IC technology has been developed capable of circuit demonstrations at > 600 GHz. Transistors demonstrate RF figures-of-merit f t > 500 GHz and f max > 1 THz. The HBTs support high current densities > 25 mA/μm 2 with a common-emitter breakdown voltage BV ceo = 3.5 V. The technology includes a multi-level thin-film wiring environment capable of low-loss THz signal routing and high integration density. A large-signal HBT model has been developed capable of accurately predicting circuit performance at THz frequencies. Circuit demonstrations include fundamental oscillators and amplifiers operating at > 600 GHz as well as integrated transmitter and receiver circuits.

A total of 20 consecutive patients with knee stiffness post total knee arthroplasty (TKA) underwent arthroscopic lysis of adhesions and manipulation plus indwelling epidural were evaluated retrospectively. Epidural catheters were placed preoperatively for an intended 6 weeks of postoperative analgesia to facilitate intensive physical therapy. The mean loss of knee extension immediately before incision was 13.5 +/- 9.1 degrees (range, 0-35 degrees) and flexion was 77.65 +/- 19.2 degrees (range, 45-125 degrees). At the 6-week and final (mean, 0.47 years) follow-up, the loss of extension was 1.5 +/- 5.1 degrees (range, -10 to +7 degrees) and 5.4 +/- 4.7 degrees (range, 0-15 degrees), respectively, and flexion was 99.7 +/- 12.3 degrees (range, 75-120 degrees) and 98.5 +/- 16.1 degrees (range, 75-130 degrees), respectively. Of the 20 patients, 2 missed their 6-week clinic visit. Improvements in motion immediately preoperative to 6-week and final follow-up were each significant (p<0.01). At examination 6 weeks postoperatively, 94.4% of patients met the definition for clinical motion success and 70% maintained success at final follow-up. Visual analog scale improved significantly from 5.4 to 2.0 (p<0.01) at 6 weeks postoperative in the 12 patients with this data recorded. On the basis of this data, use of tunneled epidurals with arthroscopic lysis of adhesions for arthrofibrosis after TKA is correlated with a high likelihood of functional success postoperatively as measured by range of motion improvement.

We report a TSV-last, heterogeneous 3D integration process for millimeter wave solid state tiles for use in the demonstration of a W-band active electronically scanned array (AESA) radar system. Each phased array tile consists of a high speed SiGe BiCMOS beamformer chip, vertically integrated with an advanced, multi-metallization level glass substrate which includes an RF interposer and a patch antenna array. This paper will briefly describe the SiGe and glass circuit layers, along with the main components of the 3D integration processing and assembly. Electrical testing of the SiGe and glass chips was conducted at various points during the integration processing, including DC and RF measurements after the two chips were bonded together. Additionally, DC testing of TSV chains was completed along with thermal cycling. The results of this work indicated a successful initial prototype demonstration of 3D heterogeneous integrated phased array tiles, which can be used for a multi-tile subarray assembly and subsequent sensor system demonstration.

(Reg Anesth Pain Med. 2015;40:276–283) Women with complex regional pain syndrome can be effectively treated using an implanted spinal cord stimulator, when conservative treatment proves ineffective. This could allow women to stop using potentially harmful analgesic medications during pregnancy.

Dear Editor, The removal of postoperative epidural catheters requires appropriate timing in patients on anticoagulants or antiplatelet agents. Current recommendations regarding clopidogrel suggest epidural catheter placement 5 to 7 days after discontinuation and to restart clopidogrel 24 hours after an epidural catheter has been removed. Premature placement or removal creates concern of precipitating a spinal epidural hematoma. A variable degree of platelet inhibition has been observed in patients on clopidogrel therapy. As a result, new tests have been developed to quantify the degree to which platelets are inhibited in these patients. These tests have gained popularity with interventional cardiologists who use the information to guide therapy. Among these new tests is the VerifyNow® PRUTest which reports a value of P2Y12 reaction units (PRU). Low values suggest a high degree of platelet inhibition, whereas a higher number reflects a greater amount of P2Y12–mediated platelet aggregation. Current cardiology literature has indicated a value of ≥ 235 ⇓ to …

Spinal cord stimulation (SCS) is an approved treatment for complex regional pain syndrome and other chronic pain conditions. These devices enable women with chronic pain to maintain relatively normal lives, with some encountering pregnancy. Use of previously implanted SCS systems in pregnant women is considered controversial due to lack of longterm prospective studies evaluating both maternal and fetal safety. Seven patients at a university pain clinic were identified as having SCS implanted before becoming pregnant. Data on these patients before, during, and after labor were collected through chart review and patient interview. Onset of labor varied among the 7 patients (2 preterm and 5 term). Mode of anesthesia for delivery included 4 neuraxial anesthetics, with 3 successfully obtaining an adequate level of anesthesia for delivery. Four general anesthetics were administered for cesarean delivery, one of which included a failed attempt at neuraxial anesthesia. All infants were born healthy. Management approaches and outcomes in our patients, as well as those previously reported are discussedwithin this article. Definitive conclusions cannot be drawn from this small cohort. We believe that management of a parturient with an implanted SCS requires careful planning between all peripartum physicians.

We are developing a new public cloud, the Massachusetts Open Cloud (MOC) based on the model of an Open Cloud eXchange (OCX). We discuss in this paper the vision of an OCX and how we intend to realize it using the OpenStack open-source cloud platform in the MOC. A limited form of an OCX can be achieved today by layering new services on top of OpenStack. We have performed an analysis of OpenStack to determine the changes needed in order to fully realize the OCX model. We describe these proposed changes, which although significant and requiring broad community involvement will provide functionality of value to both existing single-provider clouds as well as future multi-provider ones.

Objective Spinal epidural hematoma is a rare, but potentially devastating, consequence of accessing the epidural space for anesthesia or interventional pain procedures. There is no consensus to stop aspirin therapy before interventional chronic pain procedures. Case Report A 73-year-old woman with postlaminectomy pain syndrome and lumbar radiculopathy underwent percutaneous spinal cord stimulator lead placement. She had been taking aspirin 81 mg/d for several years. Twenty-four hours later, she developed an epidural hematoma. Prompt recognition and surgical management resulted in no long-term neurological sequelae. Conclusions The only variable that could have led to our patient’s epidural hematoma is aspirin. This is the first reported case of aspirin leading to an epidural hematoma following an interventional chronic pain procedure. Prior to interventional pain procedures, one should contemplate cessation of aspirin therapy because there are, at present, no consensus guidelines to direct such a decision.

We report on progress in developing a travelling wave tube amplifier with significant gain and power at 220 GHz. This paper provides an overview of the program, describing fabrication and test of slow-wave structures with bandwidths exceeding 50 GHz centered at 220 GHz, the production of a sheet electron beam, development of a solid state preamplifier delivering 50 mW to the tube with > 17 dB of gain and beam-wave simulation of the entire circuit leading to expected output powers of over 50 W. Two further papers from the group are also submitted to IVEC: from UC Davis describing the interaction structure fabrication and hot test, and from CPI describing the sheet electron beam, TWT design and beam - wave simulations. The tube is currently under test and results will be reported in this paper.