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

FogTrust: Fog-Integrated Multi-Leveled Trust Management Mechanism for Internet of Things

The Internet of Things (IoT) is widely used to reduce human dependence. It is a network of interconnected smart devices with internet connectivity that can send and receive data. However, the rapid growth of IoT devices has raised security and privacy concerns, with the identification and removal of compromised and malicious nodes being a major challenge. To overcome this, a lightweight trust management mechanism called FogTrust is proposed. It has a multi-layer architecture that includes edge nodes, a trusted agent, and a fog layer. The trust agent acts as an intermediary authority, communicating with both IoT nodes and the fog layer for computation. This reduces the burden on nodes and ensures a trustworthy environment. The trust agent calculates the trust degree and transmits it to the fog layer, which uses encryption to maintain integrity. The encrypted value is shared with the trust agent for aggregation to improve the trust degree’s accuracy. The performance of the FogTrust approach was evaluated against various potential attacks, including On-off, Good-mouthing, and Bad-mouthing. The simulation results demonstrate that it effectively assigns low trust degrees to malicious nodes in different scenarios, even with varying percentages of malicious nodes in the network

Dynamic channel estimation-aware routing protocol in mobile cognitive radio networks for smart IIoT applications

Cognitive Radio Networks (CRNs) have become a successful platform in recent years for a diverse range of future systems, in particularly, industrial internet of things (IIoT) applications. In order to provide an efficient connection among IIoT devices, CRNs enhance spectrum utilization by using licensed spectrum. However, the routing protocol in these networks is considered one of the main problems due to node mobility and time-variant channel selection. Specifically, the channel selection for routing protocol is indispensable in CRNs to provide an adequate adaptation to the Primary User (PU) activity and create a robust routing path. This study aims to construct a robust routing path by minimizing PU interference and routing delay to maximize throughput within the IIoT domain. Thus, a generic routing framework from a cross-layer perspective is investigated that intends to share the information resources by exploiting a recently proposed method, namely, Channel Availability Probability. Moreover, a novel cross-layer-oriented routing protocol is proposed by using a time-variant channel estimation technique. This protocol combines lower layer (Physical layer and Data Link layer) sensing that is derived from the channel estimation model. Also, it periodically updates and stores the routing table for optimal route decision-making. Moreover, in order to achieve higher throughput and lower delay, a new routing metric is presented. To evaluate the performance of the proposed protocol, network simulations have been conducted and also compared to the widely used routing protocols, as a benchmark. The simulation results of different routing scenarios demonstrate that our proposed solution outperforms the existing protocols in terms of the standard network performance metrics involving packet delivery ratio (with an improved margin of around 5–20% approximately) under varying numbers of PUs and cognitive users in Mobile Cognitive Radio Networks (MCRNs). Moreover, the cross-layer routing protocol successfully achieves high routing performance in finding a robust route, selecting the high channel stability, and reducing the probability of PU interference for continued communication

Molecular and Morphological Characterization of <i>Eimeria crandallis</i> Isolated from Deer (<i>Cervidae</i>) in Different Captive Animals

Coccidiosis is a protozoan disease that is characterized by diffuse diarrhea, dehydration, emaciation accompanied by moderate morbidity and mild mortality in animals and birds. The current study targeted the molecular characterization of Eimeria isolates in captive deer from different localities in Lahore. The host species was the Cervidae family, such as Hog deer (Axis porcinus) and Punjab urial (Ovis aries vignei). The Eimeria crandallis was isolated from zoo animals. The DNA was extracted from oocysts and amplified by using reported oligonucleotide primers that exhibited the 809 bp product. These were analyzed by using the small subunit 18S rRNA gene-based evolutionary relationship with 36 other Eimeria species reported in caprine, cervinae, bovines, avians, and rodents. Light microscopic examination exhibited 3.29% (7/213) Eimeria-positive fecal samples with morphological features, including sub-spherical forms, the presence of micropyle with polar cap, and oocysts diameters (μm) ranging from 24.32 ± 1.61 to 18.94 ± 1.51. The phylogenetic tree constitutes four distinct clusters with relatively higher values. The evolutionary network showed that sequences were clustered in the monophyletic group of Eimeria species reported in caprine and cervinae. The nucleotide and amino acid sequence similarity matrix analysis exhibited 99.5–99.9% identity of the study isolates with Eimeria crandallis (AF336339). This study provides relevant baseline data to develop strategic control measures for coccidiosis in zoo animals. However, further investigations are required to place the hog deer and Punjab urial-derived E. crandallis into the caprine-originated cluster

Exome sequencing identifies rare damaging variants in the ATB8B4 and ABCA1 genes as novel risk factors for Alzheimer's disease

BACKGROUND: Damaging rare variants in the TREM2, SORL1 and ABCA7 genes have been associated with an increased risk of developing Alzheimer's Disease (AD) with odds ratios that were not observed since the identification of the main AD genetic risk factor, the APOE-ε4 allele. Here, we aimed to identify additional AD-associated genes by investigating the burden of rare damaging variants in the exomes of AD cases and controls. METHOD: On a single server, we analyzed in two stages, the data from 52,270 exome sequences from several independent datasets from Europe and the United States. After comprehensive QC, Stage-1 and Stage-2 datasets comprised in total 16,396 AD cases (5,672 EOAD) and 18,107 controls with European ancestry. All detected non-synonymous and loss-of-function rare variants were prioritized by REVEL and LOFTEE, and analyzed in a per-gene burden analysis. After a Stage-1 discovery analysis, we replicated findings in an independent dataset (Stage-2). We combined the Stage-1 and Stage-2 datasets and determined, for each gene, the features of the variants that drive the burden-associations. RESULTS: We confirmed the AD-association of rare damaging variants SORL1, TREM2, ABCA7, and newly identified a significant AD-association of rare damaging variants in the ATP8B4 and ABCA1 genes. In addition, we find a strong indication for the AD-association of ADAM10 and SRC genes (Stage-2 p<0.05). For most genes, we observed a larger effect size for LOF variants compared to missense variants (Figure-A). High-impact variants in these genes are mostly extremely rare and enriched in AD patients with early ages at onset (Figure-B). CONCLUSION: We identified, for the first time, the AD-association of rare damaging variants in two genes: (i) microglial ATP8B4 which is involved in phospholipid transport, and (ii) ABCA1 which plays a critical role in lipidation of apoE thereby supporting Aβ processing. Further, we found strong evidence for the AD-association of damaging variants in ADAM10 and SRC genes. ADAM10 is involved in the proteolytic processing of APP, while SRC is a Non-Receptor Tyrosine Kinase which binds PTK2B/Pyk2, a known AD risk factor. Together, our study provides further evidence for the role of Aβ and microglia in AD pathophysiology

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes