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

Industry 4.0 in Resource Efficient and Cleaner Production: A case study from the food sector in Jordan

The concentration of CO2 in the atmosphere has reached 400ppm, a higher level than at any time in the history. As clearly referred at IPCC reports, human activity has been behind this extraordinary increase. Transition to a net-zero at industries is one of the crucial measures to meet the international commitments regarding climate change and thus keep the global warming below the 1.5C° limit. Resource Efficient and Cleaner Production (RECP) provides practical example of de-coupling between economic growth from environmental degradation and thus support achieving the net zero transition. In that context, RECP has been applied at 12 industries in Jordan resulted in saving of over 1.6 million Jordanian Dollars (JOD) annually, 22,181 MWh/yr of energy; 63,844 m3/yr of water; 404 tons/yr of raw material and reduction of 8,086 tons/yr of CO2 emissions. Integrating industry 4.0 tools into RECP has been shown to be very efficient as the industries have become able to monitor and validate all saving data on real time bases and optimize using natural resources accordingly. Saving measures and performance evaluation were linked with IoT sensors and Blockchain at one food industry in Jordan and found to be accurate and very helpful to assess input-output outflow within the industry boundary. Employing IoT with blockchain to facilitate collecting data related to RECP at industry level can be a great advantage to RECP and help in monitoring carbon footprint accurately. It is recommended to scale up RECP-industry 4.0 model to other industries and leverage this experience to expedite transition to circular economy

Industry 4.0 in Resource Efficient and Cleaner Production: A case study from the food sector in Jordan

The concentration of CO2 in the atmosphere has reached 400ppm, a higher level than at any time in the history. As clearly referred at IPCC reports, human activity has been behind this extraordinary increase. Transition to a net-zero at industries is one of the crucial measures to meet the international commitments regarding climate change and thus keep the global warming below the 1.5C° limit. Resource Efficient and Cleaner Production (RECP) provides practical example of de-coupling between economic growth from environmental degradation and thus support achieving the net zero transition. In that context, RECP has been applied at 12 industries in Jordan resulted in saving of over 1.6 million Jordanian Dollars (JOD) annually, 22,181 MWh/yr of energy; 63,844 m3/yr of water; 404 tons/yr of raw material and reduction of 8,086 tons/yr of CO2 emissions. Integrating industry 4.0 tools into RECP has been shown to be very efficient as the industries have become able to monitor and validate all saving data on real time bases and optimize using natural resources accordingly. Saving measures and performance evaluation were linked with IoT sensors and Blockchain at one food industry in Jordan and found to be accurate and very helpful to assess input-output outflow within the industry boundary. Employing IoT with blockchain to facilitate collecting data related to RECP at industry level can be a great advantage to RECP and help in monitoring carbon footprint accurately. It is recommended to scale up RECP-industry 4.0 model to other industries and leverage this experience to expedite transition to circular economy

DERIVATION OF PLANK ENERGY EQUATION FROM MAXWELL'S EQUATIONS

In this work the expression for the electromagnetic energy is derived from Maxwell’s equations; and found a useful energy relation. This expression for displacement current density is together with relation between amplitude and particles density is used to find electromagnetic energy. This energy is found to be typical to plank quantum energy formula. Another derivation is made to find classical oscillator energy from photon plank energy relation