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

Internal Technology Transfer in the Sudan: The Dichotomy Between Agricultural Research and Agricultural Practice

Sudan is the largest country in Africa' and boasts the largest farm in the world. Sudan is a predominately agricultural economy, agriculture employs more than eighty percent of the country's labour force and its industry. The national agricultural research institutions are charged with the key responsibility of implementing sustainable agricultural growth and development in Sudan. By adoption of demonstrable benefit farms, the research institutions view their contribution as providing improvements to traditional Sudanese practices rather than focusing on developing new techniques. Any research institution must have methods of improving farming practices and the pertinent test of their relevance is improved management practices.Crop productivity is extremely low and does not exceed thirty percent of the level attained in research or demonstration fields; the difficult economic position of the country has adversely affected the activities of the agricultural research institutions; technology generation is greatly hampered; the extension service is fragmented and its efforts are conned to a small number of farmers; the research institutions are weakened due to frequent staff turnover, lack of continuity in the research agenda and inadequacies in management and hence their impact is limited.The main purpose of this study is to critically evaluate the implementation capacity constraints which exist in formal agricultural research and the impact this has on the development of the agricultural sector of the Sudanese economy. The study also attempts to provide a better understanding of the relationships between low productivity in Sudan and the determinants of this.The data for this research were obtained from a field survey carried out in 1999. In the survey, a total of 120 farmers from the Gezira Scheme, 84 researchers from the Agricultural Research Corporation, 33 academic staff from the Gezira University as well as extensionists from the Central State were successfully interviewed.The research explores various aspects of the internal technology transfer system and the productivity gap in traditional agriculture. A critical review of the theoretical and empirical literature on technology transfer has been conducted in the study.It is obvious that economic analysis alone will not provide a satisfactory solution to the type of problems investigated in the study as these issues and problems also have political and socio-cultural dimensions. Therefore, the proposed solutions simply seek to change the behaviours of both individuals and institutions. To do this it is necessary to recognise all the dimensions of the technology transfer problem.This study provides insights into the influence of demographic, socio-economic, cultural, technical and decision-making factors on technology transfer and productivity in Sudan. The thesis concludes with discussion of key policy implications and areas for further research. The findings of this research should assist in guiding planners and policy-makers in improving the internal technology transfer system and perhaps in enabling agricultural productivity to improve in the Sudan

Optimized V‐Doped Defective TiO2/α‐(Fe2O3)1‐x(Cr2O3)x Heterojunctions for Photo‐Assisted Supercapacitor Devices: Insights on the Materials Integrity and Dual Conversion‐Storage Mechanism

Abstract Energy conversion and storage integrated power units suffer from multiple engineering issues. Replacing two devices (solar cell and supercapacitor assembly) with one device (photo‐enhanced supercapacitor‐ PSC) requires materials with emerged dual solar‐electrochemical storage attributes. Herein, a propitious approach is developed to fabricate all visible light‐enhanced semisolid flexible PCS. Nanoflakes‐based p‐n junction α‐(Fe2O3)1‐x(Cr2O3)x photocathode is synthesized directly on industrial waste stainless steel mesh (316L‐SS). Alongside, three TiO2‐based electrodes are utilized as positive photoactive electrodes. Tuning the optical properties of TiO2 is displayed via doping with mixed valence vanadium (V4+/V5+) together with thermal hydrogen annealing. This is revealed via the reduction of the bandgap energy from 2.89 to 2.15 eV, which can be ascribed to the induced oxygen vacancies. The device can sustain up to 1.6 V potential window with 91% stability after 350 successive charge/discharge cycles with the possibility of performance regeneration to its 100% retention. An illustration of the photo‐storage mechanism is proposed based on the X–ray photoelectron spectroscopy, X–ray crystallography, and band position/alignment results. Quasi‐reversible water splitting/formation is concluded as the main storage mechanism in the semisolid state electrolyte under illumination conditions

Visualising Patterns Associated with Adverse Drug Reactions in French Forums

International audienceAs social media are an interesting source of information for pharmacovigilance, we implemented a novel visualisation method for pharmacovigilance specialists applied to French discussion forums. A word embedding model was trained on posts to facilitate the identification of patterns associated with adverse drug reactions

Fabrication of polyhedral Cu–Zn oxide nanoparticles by dealloying and anodic oxidation of German silver alloy for photoelectrochemical water splitting

A significant effort has been dedicated to the synthesis of Cu–Zn oxide nanoparticles as a robust photocathode material for photoelectrochemical water splitting. Cu–Zn oxide nanoparticles were formed by controlled anodization of German silver (Cu–Zn–Ni) alloy in an aqueous electrolyte. Scanning electron microscopy (SEM) demonstrates the dependence of the obtained nanostructures on the anodization time. The X-ray diffraction (XRD) patterns showed the formation of copper oxide (CuO) and zinc oxide (ZnO) nanoparticles with good stability. This was also confirmed by the compositional X-ray photoelectron spectroscopy (XPS) analysis. The obtained polyhedral nanoparticles showed high optical activity with adequate bandgap energy. These optimized nanoparticles achieved boosted photocurrent of − 0.55 mA/cm2 at − 0.6 V vs. SCE under AM 1.5 illumination, confirming the role of the optimized dealloying and thermal treatment in tuning the photoelectrochemical performance of the material

Assessment of zootechnical parameters, intestinal digestive enzymes, haemato-immune responses, and hepatic antioxidant status of Pangasianodon hypophthalmus fingerlings reared under different stocking densities

A 3-month experiment was designed to investigate the effects of different stocking densities on growth, stress markers, intestinal digestive enzymes, hepatic antioxidant biomarkers, serum immunity, and survivability of striped catfish, Pangasianodon hypophthalmus. The relationship between fish stocking densities and water quality parameters was also assessed. Healthy fish (n = 1260 individuals, 17.52 ± 0.20 g) were raised in twelve fiberglass tanks. Triplicate fish groups with stocking densities of 60, 90, 120, or 150 fish per 1 m3 were designed, further referred to as SD60, SD90, SD120, and SD150 groups. Fish feeding was done using a commercially purchased well-balanced diet three times per day with a feeding rate of 3% of the wet fish weight. Results revealed that un-ionized ammonia, nitrite, and pH were significantly elevated, and dissolved oxygen levels were decreased significantly with increasing the stocking densities. The survival rates and growth significantly decreased with increasing fish stocking densities. The intestinal lipase, protease, trypsin, and amylase enzymes decreased significantly (P < 0.05) along with increased stocking densities. Moreover, significant decreases were noticed in total protein, lysozyme activity, and globulin levels when the stocking density was higher than 60 fish/m3. Conversely, serum stress biomarkers (such as blood glucose and cortisol), transaminases, alkaline phosphatase, and blood urea nitrogen were significantly elevated with increasing stocking densities. Hepatic CAT, SOD, and T-AOC were decreased; meanwhile, hepatic MDA levels were significantly increased, together with the stocking rates. In the end, we found that the SD150 group recorded the lowest growth rates, immune responses, and antioxidant capacity and the highest stress markers as blood glucose and cortisol. In this context, we can conclude that the stocking 60 fish/m3 resulted in better growth, survival, immunity, antioxidant status, and overall performances of striped catfish. Graphical Abstract: [Figure not available: see fulltext.]