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

Stratigraphic and morphologic evidence of the Holocene evolution of the Italian and Slovenian Waters (Northern Adriatic)

Il settore pi\uf9 settentrionale del Mare Adriatico, data la bassa pendenza del suo fondale, \ue8 un\u2019area particolarmente sensibile alle variazioni del livello marino che, durante il Quaternario recente, hanno causato importanti cambiamenti paleoambientali. Questa zona, situata tra l\u2019Istria, il Carso e la Pianura Veneto- Friulana, \ue8 suddivisa tra le acque territoriali italiane, slovene e croate e, nel passato, tale frammentazione amministrativa ha fortemente limitato gli studi. Nel maggio 2012 un team di ricercatori italiani e sloveni ha effettuato il rilevamento della piattaforma slovena e italiana a bordo della nave oceanografica \u201cUrania\u201d. Durante la crociera, denominata NAD2012, sono state acquisite circa 400 NM di profili sismo acustici CHIRP-sonar e, nelle acque italiane, sono stati effettuati 10 carotaggi a gravit\ue0. I nuovi dati hanno consentito di osservare in continuit\ue0 la transizione stratigrafica tra la pianura alluvionale friulana e la costa rocciosa dell\u2019Istria. L\u2019assetto generale del Nord Adriatico era stato recentemente ricostruito grazie ai dati geofisici, batimetrici e stratigrafici raccolti durante altre crociere effettuate per la realizzazione della Carta Geologica dei Mari Italiani [Trincardi et al., 2011]. Nella piattaforma slovena lo studio delle morfologie del fondale \ue8 stato consentito da un DEM di altissima risoluzione prodotto negli ultimi anni dalla societ\ue0 Harpha Sea tramite rilievi batimetrici multibeam. Il DEM ha inoltre consentito la precisa pianificazione dei profili geofisici acquisiti durante la crociera NAD2012. L\u2019area tra Monfalcone e Pirano \ue8 caratterizzata da depositi marini olocenici fini, con uno spessore massimo di 25 m presso Pirano che si assottiglia verso la costa friulana. Questo corpo sigilla la pianura alluvionale che caratterizzava la zona fino a circa 9,5 ka cal BP [Covelli et al., 2006], quando l\u2019innalzamento eustatico ha portato l\u2019Adriatico a sommergere il Golfo di Trieste. Lungo la costa orientale l\u2019antica pianura \ue8 contraddistinta da un complesso di dossi fluviali, con una direzione ENE-WSW, alimentati dalle valli che drenano il Carso e l\u2019Istria. Invece, dalla piattaforma italiana fino alla baia di Capodistria, il DEM evidenzia un percorso meandriforme inciso, parzialmente sepolto dal delta olocenico dell\u2019Isonzo e che corrisponde ad un probabile percorso tardoglaciale di questo fiume. Anche al largo di Chioggia si riconosce un esteso sistema idrografico inciso di et\ue0 post-LGM, successivamente riempito da depositi estuarini e lagunari, probabilmente formato dal Po. Bibliografia Covelli, S., Fontolan, G., Faganeli, J., Ogrinc, N., (2006). Anthropogenic markers in the Holocene stratigraphic sequence of the Gulf of Trieste (northern Adriatic Sea). Marine Geology, 230, 29-51. Trincardi, F., Argnani, A., Correggiari, A.M., (2011). Note illustrative della Carta Geologica dei Mari Italiani alla scala 1:250.000 \u2013 Foglio NL 33-7 Venezia. S.EL.CA., Firenze, 151 pp

Stratigraphic and morphologic evidence of the Holocene evolution of the Italian and Slovenian waters (northern Adriatic)

The seabed of the northernmost part of Adriatic Sea is a key area to understand the processes related to Holocene sea-level and climatic variations. This zone, which lies between Istria Peninsula, Karst and the Friulian Plain, is divided between Italian, Slovenian and Croatian territorial waters and this administrative fragmentation has strongly limited international cooperation in the past. In May 2012 a team of Italian and Slovenian researchers, on-board of the research vessel “Urania”, surveyed the shelf between Italian and Slovenian coasts. During cruise, named NAD2012, about 400 NM of CHIRP-sonar seismo-acoustic profiles were acquired in the whole area and 10 gravity cores were collected in the Italian waters. The new data gathered during NAD2012 cruise allowed for the first time to observe in continuity the stratigraphic transition from the alluvial plain of Friuli to the rocky coast of Istria. A robust chrono-stratigraphical framework of the general setting of the Northern Adriatic shelf is supported by the geophysical, bathymetric and stratigraphic data collected during cruises VE2004 and VE2005, that led to the production of the geological map of the Italian seabed, northern of Po river mouth (Trincardi et al., 2011). In the last years Harpha Sea carried out a multibeam bathymetric survey of the Slovenian Waters, leading to the production of a very high-definition DEM. This is revealed as a fundamental tool for understanding the sea-floor morphologies and to plan the acquisition of the new seismo-acoustic profiles during NAD2012. The area between Monfalcone and Piran Bay is characterized by a mud-dominated body consisting of Holocene marine deposits, with a maximum thickness of about 25 m in Piran Bay and that thins toward the Friulian coast, where the delta system of Isonzo (Soča) River is present. The marine sedimentary body seals the alluvial plain that occupied the area until ca. 7.5 ka BC, when sea-level rise led the Adriatic to re-occupy the Gulf of Trieste (Ogorelec, 1981; Covelli et al., 2006; Trincardi et al., 2011). The evolution of the investigated area is constrained by a main threshold corresponding to the deep morpho-structural depression existing in front of Savudrija Promontory. Connected to the first depression, some very large submarine dunes characterize the NW corner of Slovenian boundary, and their origin seem to be related to main stream entering in the northernmost Adriatic sector with a counterclockwise direction. Another shallower but important erosional scour is present in front of Piran Promontory. The ancient alluvial plain is characterized by a complex network of fluvial ridges, with a general ENE-WSW direction, fed by the valleys draining Karst and Istria; moreover the DEM highlight an incised meandering paleochannel, recognizable from the Italian shelf to Koper Bay, partly sealed by the deltaic progradation of the Isonzo River. References S. Covelli, G. Fontolan, J. Faganeli, N. Ogrinc, 2006. Anthropogenic markers in the Holocene stratigraphic sequence of the Gulf of Trieste (northern Adriatic Sea). Marine Geology, 230, 29-51. B. Ogorelec, M. Mišič, M., A. Šercelj, F. Cimerman, J. Faganeli, P. Stegnar, 1981. The sediment of the saltmarsh of Sečovlje. Geologija 24, 179–216. F. Trincardi, A. Argnani, A. Correggiari, 2011. Note illustrative della Carta Geologica dei Mari Italiani alla scala 1:250.000 – Foglio NL 33-7 Venezia.S.EL.CA., Firenze, 151 pp

Holocene evolution of the Northern Adriatic Platform: morphologic and stratigraphic evidence

The northernmost part of Adriatic Sea lies between Istria, Karst and the Friulian Plain and it is divided between Italian, Slovenian and Croatian waters. A robust chrono-stratigraphic framework of the Northern Adriatic shelf was supported by the geophysical, bathymetric and stratigraphic data collected during cruises VE2004, VE2005 and RISA2009, that led to the production of the geological map of the Italian seabed. Moreover, in the last years Harpha Sea Inc. carried out a multibeam bathymetric survey of the Slovenian waters, leading to the production of a very high-resolution DEM. This was a key tool for understanding the sea-floor morphologies. During cruise NAD2012 the oceanographic vessel \u201cUrania\u201d surveyed the Italian and Slovenian shelf, acquiring 750 km of CHIRP-sonar seismo-acoustic profiles and 10 gravity cores. These new data allowed for the first time to observe in continuity the transition from the rocky coast of Istria to the Friuli plain. The area between Monfalcone and Piran Bay is characterized by a mud-dominated body, consisting of Holocene marine deposits, with a maximum thickness of about 25 m in Piran Bay and that thins toward the Friulian coast, where the delta system of Isonzo River (Soca in Slovenian) is present. The marine sediments seal the alluvial plain that characterized the area until ca. 7.5 ka BC, when sea-level rise led the Adriatic to re-occupy the Gulf of Trieste. The ancient alluvial plain is characterized by a complex network of fluvial ridges fed by the valleys draining Karst and Istria; moreover, DEM highlight an incised meandering paleochannel, recognizable from the Italian shelf to Koper Bay. The evolution of the Trieste Gulf was constrained by a main morphologic threshold corresponding to the deep morpho-structural depression existing in front of Savudrija Promontory. Some very large submarine dunes are connected to this incision

Fiscal Year 2006

This document provides an understanding of the near and long term computing and I/O resources in the Secure Computing Facility (SCF) and Open Computing Facility (OCF). Requirements for data flows, storage capacities and transfer rates are determined. Recommendations are made for architectures, timeframes for major deliverables, and procurements for the next fiscal year