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Background The authors hypothesized that both perineural and systemic dexamethasone as adjuncts to bupivacaine increase the duration of an ulnar nerve block compared with bupivacaine alone, and that systemic dexamethasone is noninferior to perineural dexamethasone. Methods The authors performed bilateral ulnar nerve blocks with 3 ml bupivacaine 5 mg/ml in 16 healthy volunteers on two trial days. According to randomization, subjects received adjunct treatment with 1 ml dexamethasone 4 mg/ml + 1 ml of saline (perineural condition) in one arm and 2 ml saline in the other arm (systemic condition, through absorption and redistribution of the contralaterally administered perineural dexamethasone) on one trial day; and 2 ml saline in one arm (placebo condition) and 2 ml of lidocaine in the other arm (lidocaine condition) on the other trial day. The primary outcome was the duration of the sensory nerve block assessed by temperature discrimination. Results Mean sensory block duration was 706 ± 94 min for the perineural condition, 677 ± 112 min for the systemic condition, and 640 ± 121 min for the placebo condition. The duration of the sensory nerve block was greater with perineural dexamethasone versus placebo (mean difference 66 min (95% CI, 23 to 108). Block duration was similar between systemic dexamethasone and placebo (mean difference 36 min; 95% CI, –30 to 103). Conclusions Perineural dexamethasone as an adjunct to bupivacaine in healthy volunteers resulted in a greater duration of an ulnar nerve block when compared with placebo. Systemic dexamethasone resulted in a similar duration as placebo. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Nanostructured TaS2 with different concentrations of intercalated Mn ions has been investigated using ac and dc magnetization measurements. The nanostructures are composed of tapes that are less than a micron wide, which themselves are comprised of tubular structures with an average diameter of about 100 nm. The sample with a concentration x=0.15 of Mn exhibited a transition from paramagnetism to a cluster glass state at approximately 8 K. The dynamics of this cluster glass state was better described by the Vogel–Fulcher–Tammann law than by critical slowing down, which suggests that the transition is not a continuous one. The cluster glass state exhibited aging-related memory, which is typically observed in canonical spin glasses and superspin glasses. The sample with x=0.23 underwent a paramagnetic to ferromagnetic transition at 85 K. Nonlinear susceptibility measurements suggest that there is another transition close to but somewhat lower than 85 K. With a small measuring field, both zero-field-cooled and field-cooled magnetizations exhibit peaks and dramatic downturns at low temperatures. The field-cooled magnetization also exhibits temperature hysteresis. The unusual behavior of the field-cooled magnetization is due to relaxation and cooling-rate effects. The overall behavior of nanostructured MnxTaS2 possesses the hallmarks of competition between clustered magnetic ground states in a disordered magnetic system.

Background Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. Methods A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n = 6279) and 2013 (validation cohort, n = 6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration. Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort. Results Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p