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

WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting

Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.Peer reviewe

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School of Energy and Chemical Engineering (Chemical Engineering)clos

A universal screening strategy for the accelerated design of superior oxygen evolution/reduction electrocatalysts

Despite advanced computational methods, it is not practical to utilize high-throughput computational screening for a large number of candidates for multi-step reactions due to intercorrelation between reaction intermediates. However, we have devised a universal computational screening strategy that can accelerate the prediction of the theoretical overpotential (eta(DFT)) for the Oxygen Evolution/Reduction Reaction (OER/ORR) by using only the adsorption free energy of O*. Our accelerated screening strategy can effectively reduce the computing time by skipping the costly calculations of adsorption free energies of OH* and OOH*. Besides, the efficiency of the accelerated screening strategy was verified using 1008 combinations of single-atom-anchored transition metal dichalcogenides. The given candidate materials are rapidly screened using our strategy and finally 32 promising catalysts are found which have a lower eta(DFT) than state-of-the-art commercial IrO2 for the OER and Pt for the ORR. Our screening strategy that uses a sequential process can narrow down the candidate space, and enables practical high-throughput computational screening of oxygen-involved reactions even for a large number of candidates

Sparse Gaussian Process Regression-Based Machine Learned First-Principles Force-Fields for Saturated, Olefinic, and Aromatic Hydrocarbons

Universal machine learning (ML) interatomic potentials (IAPs) for saturated, olefinic, and aromatic hydrocarbons are generated by using the Sparse Gaussian process regression algorithm. The universal potentials are obtained by combining the potentials for the previously trained alkane/polyene systems and the potentials generated with the presently trained cyclic/aromatic hydrocarbon systems, along with the newly trained cross-terms between the two systems. The ML-IAPs have been trained using the PBE + D3 level of density functional theory for the on-the-fly adaptive sampling of various hydrocarbon molecules and these clusters composed of small molecules. We tested the ML-IAPs and found that they correctly predicted the structures and energies of the ??-carotene monomer and dimer. Also, the simulations of liquid ethylene reproduced the molecular volume and the simulations of toluene crystals reproduced higher stability of the ??-phase over the ??-phase. These ab initio-level force-fields could eventually evolve toward universal organic/polymeric/biomolecular systems. ?? 2022 The Authors. Published by American Chemical Society

Dual-curable isocyanate crosslinking agents blocked by methacrylate-functionalized pyrazoles with lower curing temperature

To develop a polyurethane-based automotive clearcoat with a lower curing temperature, methacrylatefunctionalized pyrazole derivatives were newly designed and synthesized as isocyanate blocking agents and their chemical structures were identified by 1H NMR. These novel blocking agents were used to block the functional groups of hexamethylene diisocyanate (HDI) trimer (commercially known as Desmodur N3300), and density functional theory simulations were performed to predict the activation energy of the deblocking process and to determine the H-N distance in the pyrazole molecules. The curing behavior of the blocked isocyanate with polyol resin at 110, 120, and 130 degrees C was investigated using an oscillatory rheometer and a rigid-body pendulum tester. In addition, their results were compared with those for a commercially available 3,5-dimethyl pyrazole-blocked HDI trimer (Desmodur PL350). The thermal properties of the clearcoat films cured at 130 degrees C were investigated using thermogravimetric analysis, differential scanning calorimetry, and dynamic mechanical analysis, and the surface mechanical properties of the cured films were evaluated using a nano-indentation tester. The novel pyrazole blocking agents contributed to lowering the deblocking temperature and enhancing the mechanical properties via supplementary radical polymerization of deblocked methacrylate-functionalized pyrazoles, resulting in interpenetrating crosslinked polymer networks. This study provides a new concept of isocyanate blocking agents with lower deblocking temperatures and higher crosslinking densities, resulting in blocked isocyanates that can be used in various coating materials

Fast atomic structure optimization with on-the-fly sparse Gaussian process potentials *

We apply on-the-fly machine learning potentials (MLPs) using the sparse Gaussian process regression (SGPR) algorithm for fast optimization of atomic structures. Great acceleration is achieved even in the context of a single local optimization. Although for finding the exact local minimum, due to limited accuracy of MLPs, switching to another algorithm may be needed. For random gold clusters, the forces are reduced to similar to 0.1 eV angstrom(-1) within less than ten first-principles (FP) calculations. Because of highly transferable MLPs, this algorithm is specially suitable for global optimization methods such as random or evolutionary structure searching or basin hopping. This is demonstrated by sequential optimization of random gold clusters for which, after only a few optimizations, FP calculations were rarely needed

Revisiting the taxonomy of the "Dinophysis acuminata complex" (Dinophyta)'

Marine dinoflagellates of the genus Dinophysis are well known for producing diarrhetic shellfish poisoning (DSP) toxins and/or pectenotoxins which have a significant impact on public health as well as on marine aquaculture. Out of more than 80 Dinophysis species recorded so far, D. cf. acuminate is the most commonly observed in coastal areas worldwide. Due to their highly similar morphological features, however, an accurate discrimination of the various D. cf. acuminate species such as D. acuminate, D. ovum, and D. sacculus under light microscopy has proven to be a difficult task to accomplish. Hence, these species have thus far been referred to as the "Dinophysis acuminate complex". Recent studies showed a discrimination between local strains of D. acuminate and D. ovum from Galician, northwestern Spain, using the mitochondrial coxi gene as a genetic marker in addition to commonly used morphological features such as size and contour of the large hypothecal plates, shape of the small cells formed as part of their polymorphic life-cycle, development of the left sulcal list and ribs, and length of the right sulcal list. In the present study, attempts were made to discriminate between D. acuminate and D. ovum following single-cell isolation of 54 "D. acuminate complex" collected from Korean coastal waters, based on the abovementioned traits. Morphological data showed that all the traits analyzed overlapped between the two species. The mitochondrial cox1 (cytochrome c oxidase subunit I) gene sequences of every isolate were also determined, but a genetic distinction between D. acuminate and D. ovum could not be confirmed, suggesting that the coxi gene is not a suitable genetic marker for discrimination between the two species. The results of this study suggest that the morphological variations observed within the "D. acuminate complex" may have been caused by several factors (e.g. different geographical locations, seasonal changes, and different environmental conditions), and that D. acuminate and D. ovum may be the same species.N