Geographic information system for water resource management, Egypt

In IDL-987

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

Assessment of Irrigation Water Performance in the Nile Delta Using Remotely Sensed Data

A comprehensive framework for irrigation water performance assessment (IWPA) based on satellite data was proposed. This framework consists of external IWPA (EIWPA) and internal IWPA (IIWPA). The EIWPA indicates the water supply as well as agricultural and economic performances. On the other hand, the IIWPA expresses the temporal and spatial performances of irrigation water use adequacy (PA), equity (PE), and dependability (PD) indicators. This framework was applied to the irrigation scheme of the Al-Qased canal in the Nile Delta, Egypt, during the winter between 2015 and 2016. The crop water requirements (ETc) were calculated using the Surface Energy Balance Algorithm for Land (SEBAL) model and Landsat 8 images. Three classes, from “good” to “poor,” to classify the EIWPA and IIWPA values were proposed. The EIWPA was classified as “poor” in irrigation efficiency (51.2%) due to the oversupply of irrigation water in relation to the ETc while the economic indicators showed that the net profit was 7.84% of the gross value of crop production. The PE, PD, and PA were classified as “fair,” which indicated a non-uniform irrigation water distribution between the head and tail branch canals. Moreover, the irrigation water was inadequate during the growing months and could not meet the ETc. The framework presented an efficient tool for the IWPA in terms of spatial, temporal, agricultural, and economic performances

The nexus between atopic disease and autoimmunity: a review of the epidemiological and mechanistic literature‡

There has been considerable interest in defining the relationship between the expression of allergic and autoimmune diseases in populations of patients. Are patients with autoimmune disease ‘protected’ from developing allergic (immunoglobulin E-mediated) diseases? Does the establishment of an atopic phenotype reduce the risk of the subsequent development of autoimmune diseases? Although there are clinical studies addressing this question, methodological problems, particularly in identification of atopic subjects, limits their usefulness. Moreover, an immune-based explanation of the observed epidemiological findings has relied on a paradigm that is currently undergoing increased scrutiny and modification to include newly defined effector cell subsets and the interaction between genetic and environmental factors, such as early endotoxin or mycobacterial exposure. To address this question, we reviewed a series of clinical reports that addressed coincidence or co-prevalence of atopy with four autoimmune diseases: psoriasis, rheumatoid arthritis, multiple sclerosis and type I diabetes mellitus. We present a model whereby active T helper type 1 (Th1) inflammation may suppress the development of atopy, and atopy may suppress the severity but not necessarily the onset of autoimmunity, and then discuss our model in the context of mechanisms of adaptive immunity with particular reference to the Th1/Th2 paradigms. Because the ultimate goal is to ameliorate or cure these diseases, our discussion may help to predict or interpret unexpected consequences of novel therapeutic agents used to target autoimmune or atopic diseases