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

中共對東協國家的外交政策

第一章是討論以兩個假設模型來解釋中共外交政策的可行性：「統一戰線模型」是以「意識型態」為主要考慮，「聯盟政策」則以「國家安全」為主要考慮。第二章是探討「東南亞國家協會」成立前，中共對東南亞政策的演變，描述中共為何由初期的擴張政策轉變為「和平共處政策」；並討論中共與印尼、中共與高棉的關係。第三章是討論中共與東協國家改善關係的前因後果，並分析彼此間的矛盾。第四章是討論美、蘇、中共在東協區域的角逐及高棉問題影響下，中共與東協國家的微妙關係。第五章是綜合中共與東協國家的關係發展史，並納入前述兩個模型作分析性的說明、解釋及預測未來的可能發展。這是本文的結論

Effect of Alkali and 1,4-Butanediol Contents on the Extraction of Lignin and Lignin-Based Activated Carbon

In the process of lignin extraction by the organic solvent method, the amount of alkali and the content of 1,4butanediol are important conditions that affect lignin yield. The effects of alkali and alcohol contents on lignin recovery, removal rate, and structure were studied. In this reaction system, the removal rate of lignin increased with the increase of alkali content but decreased with the increase of alcohol content. Fourier transform infrared (FT-IR) analysis showed that the phenol hydroxyl group and the ether bond in lignin had different trends in different alkali and 1,4-butanediol environments, and four different infrared parameters in lignin had an obvious linear relationship. Gel permeation chromatography (GPC) results showed that high alkali content and high 1,4-butanediol content could lead to the fragmentation of lignin. In addition, lignin extracted from alkali-quantity factor series was selected to prepare activated carbon, CaCl2 was selected as the activator, and its effects were studied. Results showed that in the process of extracting lignin, on the one hand, NaOH content affects the functional groups of activated carbon by affecting the aromatic structure of lignin; on the other hand, the NaOH content affects the graphitization degree and specific surface area of activated carbon by affecting the removal rate and the molecular weight of lignin

Gold-tin co-sensitized ZnO layered porous nanocrystals: enhanced responses and anti-humidity

High responses and good selectivity are key sensing properties of metal oxide (MOX) gas sensors. However, it is still a major challenge for a single MOX gas sensor to achieve both of them. Specially, the research in the field of high performance gas sensors has been hindered by negative effects of the typical interference, relative humidity ( RH). In this paper, we report the successful preparation of gold-tin co-sensitized ZnO layered porous nanocrystals (Au-5Sn-ZLPCs) via a sequential solvothermal reaction and depositionreduction method. Based on Sn dopants sensitized ZLPCs, the introduction of Au decoration can act as a secondary sensitized element on the crystal surfaces of ZnO. The special synergy between noble metals and oxides can introduce additional catalytic effects to further improve sensing properties. As a result of Au-Sn co-sensitization, sensing properties of sensors towards reducing VOC gas were significantly enhanced, while those towards oxidizing ozone gas were different to each other. Besides the typical sensing properties including responses, operating temperature, response &amp; recovery properties, etc., Au-Sn co-sensitized samples significantly reduced negative effects of RH on responses to both reducing and oxidizing gases (good anti-humidity).</p