Immersive virtual reality is proving effective as a non-pharmacologic analgesic for a growing number of painful medical procedures. External fixator surgical pins provide adjunctive stability to a broken pelvic bone until the bones heal back together, then pins are removed. The purpose of the present case study was to measure for the first time, whether immersive virtual reality could be used to help reduce pain and anxiety during the orthopedic process of removing external fixator pins from a conscious patient in the orthopedic outpatient clinic, and whether it is feasible to use VR in this context. Using a within-subject within wound care design with treatment order randomized, the patient had his first ex-fix pin unscrewed and removed from his healing pelvic bone while he wore a VR helmet and explored an immersive snowy 3D computer generated world, adjunctive VR. He then had his second pin removed during no VR, standard of care pain medications. The patient reported having 43% less pain intensity, 67% less time spent thinking about pain, and 43% lower anxiety during VR vs. during No VR. In addition, the patient reported that his satisfaction with pain management was improved with the use of VR. Conducting simple orthopedic procedures using oral pain pills in an outpatient setting instead of anesthesia in the operating room greatly reduces the amount of opioids used, lowers medical costs and reduces rare but real risks of expensive complications from anesthesia including oversedation, death, and post-surgical dementia. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive non-pharmacologic form of treatment for acute pain and anxiety during medical procedures in the orthopedic outpatient clinic. Recent multi-billion dollar investments into R and D and mass production have made inexpensive immersive virtual reality products commercially available and cost effective for medical applications. We speculate that in the future, patients may be more willing to have minor surgery procedures in the outpatient clinic, with much lower opioid doses, while fully awake, if offered adjunctive virtual reality as a non-pharmacologic analgesic during the procedure. Additional research and development is recommended.

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Summary The effect of seed inoculation with Azotobacter spp. or Azospirillum spp., and garbage amendment (0.5%), on the growth of wheat was studied in a field experiment under sub-tropical conditions. Two levels of N fertilizer were applied, the usual field rate (150 kg N ha -1 ) and haft this amount. Tillering of plants, dry matter contents and rdtrogenase activity were determined 30, 60 and 90 days after sowing. At the end of the experimental period, spore numbers and percentage of mycorrhizal infection were observed in the rhizosphere and root systems of plants. Straw and grain yields were also determined. The results of this study showed that seed inoculation and]or organic amendment stimulated plant growth, nitrogenase activity and mycor~hizal infection. This was more noticeable with Azotobacter than with Azospirillum. Inoculation with Azotobacter together with 1/2 N dose and organic amendment was the most effective application (19.75 and 10.70tha -1 were recorded for straw and grain yield, respectively).

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