Background: Studies of radiofrequency ablation (RFA) of genicular nerves have reportedly significantly decreased pain up to 3 months post ablation, but no longer term effects have been reported. We performed an analysis of long-term pain relief of 31 RFA procedures of the genicular nerves to analyze the degree of pain relief past 3 months, culminating at 6 months. Objective: To evaluate the long term efficacy of genicular nerve ablation for management of chronic knee pain due to osteoarthritis. Study Design: Chart review and study design was approved by Newark Health Sciences IRB. Chart review and follow-up was performed on all patients who underwent genicular nerve RFA during the period of February 2014 through August of 2015. During this inclusion period 41 genicular nerve RFAs were performed on 31 patients, 5 patients received RFA procedure in both knees. Patient follow-up was performed via telephone interview or in-office visit at least 3 months and 6 months post RFA. Settings: Procedures were performed in Medical Special Procedures at University Hospital in Newark, NJ, and the Pain Management Center at Overlook Medical Arts Center in Summit, NJ. Methods: Chart review and study design was approved by Newark Health Sciences Institutional Review Board. Chart review was performed from February 2014 and continued through August 2015. Patient follow-up was conducted at 3 and at least 6 months post treatment to gauge degree of pain relief (0 – none, 100% – complete), their current day’s pain score, other treatment modalities tried before RFA, and the medications used. Patients were asked to quantify their satisfaction with procedure length, pre-procedure anxiety, complications, and if they would recommend this procedure to others. Primary and secondary goals were the duration of pain relief after RFA, the quality of pain relief, and the efficacy of our approach for RFA of genicular nerves versus prior published techniques. Results: At 3 month follow-up, the average pain relief was 67% improvement from baseline knee pain, 0% being no relief and 100% being complete relief, and average 0 – 10 pain score was 2.9. At 6 month follow-up, of those who described pain relief at 3 months, 95% still described pain relief. This group’s average percent pain relief was 64% and average day’s 0 – 10 pain score 3.3. Limitations: Our study included a retrospective component in chart review followed by prospective follow-up, only 76% of patients were able to participate in the interview process. Furthermore, some patients suffered from other chronic pain ailments, most commonly chronic back pain, which at times disturbed the patient’s ability to focus on solely knee pain. Conclusions: Based on patient interviews and data collection, RFA of genicular nerves can supply on average greater than 60% pain relief in our patient population for as long as 6 months. Key words: Osteoarthritis, knee osteoarthritis, chronic knee pain, radiofrequency ablation, nerve ablation, genicular nerves, long-term pain relief

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This study develops a procedure for seasonal forecasting river discharge from headwaters above strategically important hydropower plants in Kyrgyzstan and Tajikistan. The El Niño Southern Oscillation, North Atlantic Oscillation, and Indian Ocean Dipole indices were used as inputs. Predictability was evaluated for average summer inflows conditional on the tercile of the preceding winter climate mode. We find that the winter Niño 3.4 index was significantly positively correlated with following summer inflows to Nurek, Andijan, and Toktogul reservoirs during the period 1941–1980. Kruskal–Wallis and Kolmogorov–Smirnov tests show significant differences in the distributions of summer inflows depending on previous winter Niño 3.4 for all three reservoirs. At Nurek, summer inflows were on average 19% greater following a winter El Niño. During 1941–2016, mean summer inflows to Nurek reservoir linked to previous November–December Niño 3.4 achieved a Heidke Hit Proportion of 51–59% (compared with 33% expected by chance). Acceptable predictions of summer inflow volume were made 44% of the time. Higher inflows are explained by a south‐westerly moisture flux that brings above average precipitation to Central Asia during winter El Niño conditions. Our procedure requires limited data, technical or computing resources—all considerations in data sparse, low capacity regions. Given planned developments of other large, headwater impoundments in Central Asia, early outlooks of discharge could contribute to improved dam safety, economic performance, and transboundary water sharing around such projects.

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Du. 11. ft. Siiiiii.v. Detroit: It is most important that we should give close attention to the acute suppurative processes in the nose. It is these processes that make I lie trouble later on.