Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Pure pursuit model when the vehicle following the X and Y axis and Stanley model

Takip eden yol, otonom araçlar için önemli bir konudur ve robotik araçlarda yaygın olarak kullanılmaktadır. alanlar . Projenin temel amacı, aracın x ve y eksenlerinde bir noktayı takip etmesini incelemektir. Bu çalışma, teorik olarak ve MATLAB simülasyon programını kullanarak, sürüş senaryosunu kullanarak ileriye bakma mesafesinin yanı sıra yolun eğriliğini çizerek yol ve saf takip denetleyicisi uygulayarak ve otomatik olarak belirlenir. Ve Pure kullanarak Pursuit Modeli ve çalışmanın belirli koşullar altında yürütüldüğü Stanley Modeline ek olarak Sonuçları görmek için koşullar ve aracın parametreleri değiştirildi ve belirli noktalar belirlendi. izlenen noktanın değeri düştüğünde, takip edilecek araç kararsızlık durumu, ağırlık merkezindeki değişikliği incelemeye ek olarak, her koşulda meydana gelir. ve aracın stabilitesi üzerindeki etkisi.The path following is an important topic for autonomous vehicle and its wide used in robotic fields .The main objective of the project is to study the vehicle's tracking of a point on the x and y axes theoretically and using the MATLAB simulation program, This study is concerned with determining the look-ahead distance using the driving scenario, as well as the curvature of the path by drawing the path and applying pure pursuit controller, and it is determined automatically. And by using the Pure Pursuit Model and in addition to the Stanley Model, where the study was conducted under certain conditions and the vehicle's parameters were changed to see the results and certain points were set for the vehicle to follow where It was found that when the value of the point being tracked decreases, a state of instability occurs under all conditions, in addition to studying the change in the center of gravity and its effect on the stability of the vehicle

Optimizing thermoelectric energy recovery from gasoline engine exhaust: A computational approach using ansys

This study explores the feasibility of recovering waste heat from a gasoline-powered internal combustion engine using a thermoelectric generator (TEG) system integrated into the exhaust line. A Toyota Corolla with a 1.6-L engine was utilized as the test platform, incorporating 22 TEC1-12706 thermoelectric modules arranged in a V-shaped configuration between the exhaust pipe and a water-cooled aluminum heat sink. Experimental measurements were conducted under static (idle) conditions at engine speeds ranging from 1500 to 4000 rpm. Key performance parameters, including exhaust gas temperature and velocity, cooling water temperatures, and the surface temperatures of the modules, were recorded alongside electrical outputs. The system exhibited a nonlinear increase in power output with engine speed, peaking at 17.08 W at 4000 rpm, with a maximum voltage of 7.3 V and current of 2.34 A. A strong correlation was identified between the temperature gradient across the modules and power generation, underscoring the importance of thermal management. Complementary thermal simulations using ANSYS validated the experimental thermal behavior and further demonstrated that increasing the temperature differential enhances electrical output. These results confirm the potential of TEG technology to improve energy efficiency in conventional vehicles by converting waste heat into useable electrical energy, particularly during idle operation

Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance

AbstractObjectiveThe aim of this study was to evaluate the effectiveness of injecting botulinum toxin A into the lower limbs of children with cerebral palsy, according to age, dose, dilution, injection site and needle placement technique (manual or ultrasound guidance).Materials and methodsAny child with cerebral palsy examined between May 2005 and May 2006 who needed botulinum toxin A injections in the adductor, hamstring, gastrocnemius and/or soleus muscles could be included. Fifty-four (54) children participated in the study, 30 of whom were injected under ultrasound guidance. The pre- and post- toxin evaluations were done through analytical clinical examination and the Gross Motor Function Measure (GMFM-88).ResultsWe found an overall clinical effectiveness for 51% of the children. This effectiveness was significantly higher for children under 6years old or over 12, especially when the doses were greater than 0.8UI/kg per muscle of Botox®, when the injected muscles were hamstrings or gastrocnemius, and when the injections were guided by ultrasound. Dilution had no effect on clinical effectiveness. Function after one month was better for 24% of the children. This functional improvement was significantly better for children under 6years old with the injections under ultrasound control.ConclusionsThis study confirms that the effectiveness of botulinum toxin injections is higher in younger children, with injected doses higher than 0.8 UI/kg per muscle of Botox® and injections guided by ultrasound