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

Dehumanisation of ‘Outgroups’ on Facebook and Twitter: towards a framework for assessing online hate organisations and actors

Whilst preventing dehumanization of outgroups is a widely accepted goal in the field of countering violent extremism, current algorithms by social media platforms are focused on detecting individual samples through explicit language. This study tests whether explicit dehumanising language directed at Muslims is detected by tools of Facebook and Twitter; and further, whether the presence of explicit dehumanising terms is necessary to successfully dehumanise ‘the other’—in this case, Muslims. Answering both these questions in the negative, this analysis extracts universally useful analytical tools that could be used together to consistently and competently assess actors using dehumanisation as a measure, even where that dehumanisation is cumulative and grounded in discourse, rather than explicit language. The output of one prolific actor identified by researchers as an anti-Muslim hate organisation, and four (4) other anti-Muslim actors, are discursively analysed, and impacts considered through the comments they elicit. Whilst this study focuses on material gathered with respect to anti-Muslim discourses, the findings are relevant to a range of contexts where groups are dehumanised on the basis of race or other protected attribute. This study suggests it is possible to predict aggregate harm by specific actors from a range of samples of borderline content that each might be difficult to discern as harmful individually

Plasmodium falciparum kelch 13 Mutations, 9 Countries in Africa, 2014–2018

The spread of drug resistance to antimalarial treatments poses a serious public health risk globally. To combat this risk, molecular surveillance of drug resistance is imperative. We report the prevalence of mutations in the Plasmodium falciparum kelch 13 propeller domain associated with partial artemisinin resistance, which we determined by using Sanger sequencing samples from patients enrolled in therapeutic efficacy studies from 9 sub-Saharan countries during 2014–2018. Of the 2,865 samples successfully sequenced before treatment (day of enrollment) and on the day of treatment failure, 29 (1.0%) samples contained 11 unique nonsynonymous mutations and 83 (2.9%) samples contained 27 unique synonymous mutations. Two samples from Kenya contained the S522C mutation, which has been associated with delayed parasite clearance; however, no samples contained validated or candidate artemisinin-resistance mutations

Environmental effects on cephalopod population dynamics

Cephalopods are a relatively small class of molluscs (~ 800 species), but they support some large industrial scale fisheries and numerous small-scale, local, artisanal fisheries. For several decades, landings of cephalopods globally have grown against a background of total finfish landings levelling off and then declining. There is now evidence that in recent years, growth in cephalopod landings has declined. The commercially exploited cephalopod species are fast-growing, short-lived ecological opportunists. Annual variability in abundance is strongly influenced by environmental variability, but the underlying causes of the links between environment and population dynamics are poorly understood. Stock assessment models have recently been developed that incorporate environmental processes that drive variability in recruitment, distribution and migration patterns. These models can be expected to improve as more, and better, data are obtained on environmental effects and as techniques for stock identification improve. A key element of future progress will be improved understanding of trophic dynamics at all phases in the cephalopod life cycle. In the meantime, there is no routine stock assessment in many targeted fisheries or in the numerous by-catch fisheries for cephalopods. There is a particular need for a precautionary approach in these cases. Assessment in many fisheries is complicated because cephalopods are ecological opportunists and stocks appear to have benefited from the reduction of key predator by overexploitation. Because of the complexities involved, ecosystem-based fisheries management integrating social, economic and ecological considerations is desirable for cephalopod fisheries. An ecological approach to management is routine in many fisheries, but to be effective, good scientific understanding of the relationships between the environment, trophic dynamics and population dynamics is essential. Fisheries and the ecosystems they depend on can only be managed by regulating the activities of the fishing industry, and this requires understanding the dynamics of the stocks they exploit