Predicting the stress-strain behaviour of zeolite-cemented sand based on the unconfined compression test using GMDH type neural network

Stabilizing sand with cement is considered to be one of the most cost-effective and useful methods of in-situ soil improvement, and the effectiveness is often assessed using unconfined compressive tests. In certain cases, zeolite and cement blends have been used; however, even though this is a fundamental issue that affects the settlement response of a soil, very few attempts have been made to assess the stress-strain behaviour of the improved soil. Also, the majority of previous studies that predicted the unconfined compressive strength (UCS) of zeolite cemented sand did not examine the effect of the soil improvement variables and strain concurrently. Therefore, in this paper, an initiative is taken to predict the relationships for the stress-strain behaviour of cemented and zeolite-cemented sand. The analysis is based on using the unconfined compression test results and Group Method of Data Handling (GMDH) type Neural Network (NN). To achieve this end, 216 stress-strain diagrams resulting from unconfined compression tests for different cement and zeolite contents, relative densities, and curing times are collected and modelled via GMDH type NN. In order to increase the accuracy of the predictions, the parameters associated with successive stress and strain increments are considered. The results show that the suggested two and three hidden layer models appropriately characterise the stress-strain variations to produce accurate results. Moreover, the UCS values derived from this method are much more accurate than those provided in previous approaches. Moreover, the UCS values derived from this method are much more accurate than those provided in previous approaches which simply proposed the UCS values based on the content of the chemical binders, compaction, and/or curing time, not considering the relationship between stress and strain. Finally, GMDH models can be considered to be a powerful method to determine the mechanical properties of a soil including the stre

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