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

Roadmap on data-centric materials science

Science is and always has been based on data, but the terms ‘data-centric’ and the ‘4th paradigm’ of materials research indicate a radical change in how information is retrieved, handled and research is performed. It signifies a transformative shift towards managing vast data collections, digital repositories, and innovative data analytics methods. The integration of artificial intelligence and its subset machine learning, has become pivotal in addressing all these challenges. This Roadmap on Data-Centric Materials Science explores fundamental concepts and methodologies, illustrating diverse applications in electronic-structure theory, soft matter theory, microstructure research, and experimental techniques like photoemission, atom probe tomography, and electron microscopy. While the roadmap delves into specific areas within the broad interdisciplinary field of materials science, the provided examples elucidate key concepts applicable to a wider range of topics. The discussed instances offer insights into addressing the multifaceted challenges encountered in contemporary materials research

Spatial analysis of human and livestock anthrax in Dien Bien province, Vietnam (2010-2019) and the significance of anthrax vaccination in livestock.

Anthrax is a serious zoonosis caused by Bacillus anthracis, which primarily affects wild herbivorous animals with spillover into humans. The disease occurs nearly worldwide but is poorly reported in Southeast Asian countries. In Vietnam, anthrax is underreported, and little is known about its temporal and spatial distributions. This paper examines the spatio-temporal distribution and epidemiological characteristics of human and livestock anthrax from Dien Bien province, Vietnam from 2010 to 2019. We also aim to define the role of livestock vaccination in reducing human cases. Historical anthrax data were collected by local human and animal health sectors in the province. Spatial rate smoothing and spatial clustering analysis, using Local Moran's I in GeoDa and space-time scan statistic in SaTScan, were employed to address these objectives. We found temporal and spatial overlap of anthrax incidence in humans and livestock with hotspots of human anthrax in the east. We identified three significant space-time clusters of human anthrax persisting from 2010 to 2014 in the east and southeast, each with high relative risk. Most of the human cases were male (69%), aged 15-59 years (80%), involved in processing, slaughtering, or eating meat of sick or dead livestock (96.9%) but environmental and unknown exposure were reported. Animal reports were limited compared to humans and at coarser spatial scale, but in areas with human case clusters. In years when livestock vaccination was high (>~25%), human incidence was reduced, with the opposite effect when vaccine rates dropped. This indicates livestock vaccination campaigns reduce anthrax burden in both humans and livestock in Vietnam, though livestock surveillance needs immediate improvement. These findings suggest further investigation and measures to strengthen the surveillance of human and animal anthrax for other provinces of Vietnam, as well as in other countries with similar disease context

Spatial analysis of human and livestock anthrax in Dien Bien province, Vietnam (2010–2019) and the significance of anthrax vaccination in livestock

Anthrax is a serious zoonosis caused by Bacillus anthracis, which primarily affects wild herbivorous animals with spillover into humans. The disease occurs nearly worldwide but is poorly reported in Southeast Asian countries. In Vietnam, anthrax is underreported, and little is known about its temporal and spatial distributions. This paper examines the spatio-temporal distribution and epidemiological characteristics of human and livestock anthrax from Dien Bien province, Vietnam from 2010 to 2019. We also aim to define the role of livestock vaccination in reducing human cases. Historical anthrax data were collected by local human and animal health sectors in the province. Spatial rate smoothing and spatial clustering analysis, using Local Moran’s I in GeoDa and space-time scan statistic in SaTScan, were employed to address these objectives. We found temporal and spatial overlap of anthrax incidence in humans and livestock with hotspots of human anthrax in the east. We identified three significant space-time clusters of human anthrax persisting from 2010 to 2014 in the east and southeast, each with high relative risk. Most of the human cases were male (69%), aged 15–59 years (80%), involved in processing, slaughtering, or eating meat of sick or dead livestock (96.9%) but environmental and unknown exposure were reported. Animal reports were limited compared to humans and at coarser spatial scale, but in areas with human case clusters. In years when livestock vaccination was high (>~25%), human incidence was reduced, with the opposite effect when vaccine rates dropped. This indicates livestock vaccination campaigns reduce anthrax burden in both humans and livestock in Vietnam, though livestock surveillance needs immediate improvement. These findings suggest further investigation and measures to strengthen the surveillance of human and animal anthrax for other provinces of Vietnam, as well as in other countries with similar disease context. Author summary Anthrax is a bacterial disease, cause by Bacillus anthracis, that can transmit from herbivorous animals to humans through close contact, eating meat of infected animals, or through environmental contamination. Anthrax can be a severe disease requiring early diagnosis and treatment to avoid fatal outcomes, disability, or financial burden to patients and their families. The disease also affects human well-being when livestock is their livelihood and an important part in agricultural practice. Anthrax is preventable by vaccine but effective strategy for vaccine distribution should be built on the characteristics of the disease in both human communities and the local animal populations. This study provides evidence on the space-time distribution and other characteristics of anthrax applying a One Health approach and geographical information analysis techniques. We show that hotspots of human disease correspond to areas of animal case reporting. We also show human incidence is reduced with livestock vaccination rates are relatively high. The study results are useful for researchers to foster investigation on other aspects of the disease and control efforts. It also provides scientific evidence for advocacy and communication on the importance of anthrax vaccination and strategic planning on vaccine production and distribution in Vietnam and other countries with similar context

InAs/InAsSb Type-II Superlattice Mid-Wavelength Infrared Focal Plane Array With Significantly Higher Operating Temperature Than InSb

We report focal plane array (FPA) results on a mid-wavelength InAs/InAsSb type-II strained layer superlattice (T2SLS) unipolar barrier infrared detector with a cutoff wavelength of 5.4 μm. For 300 K background in the 3-5-μm band, f/2 aperture, an FPA operating at 150 K exhibits a mean noise equivalent differential temperature (NEDT) of 18.5 mK, and an NEDT operability of 99.7%. The NEΔT distribution has a width of 8 mK, with no noticeable distribution tail, indicating excellent uniformity. The mean noise-equivalent irradiance is 9.1 × 1011 photons/sec-cm2. The mean quantum efficiency is 49.1% without antireflection coating, and the mean specific detectivity (D*) is 2.53 × 1011 cm-Hz½/W. Benefitting from an absorber material with a much longer Shockley-Read-Hall minority carrier lifetime, and a device architecture that suppresses generation-recombination and surface-leakage dark current, the InAs/InAsSb T2SLS barrier infrared detector FPA has demonstrated a significantly higher operating temperature than the mid-wavelength infrared market-leading InSb

Provincial, District, and commune level administration of Dien Bien province.

Maps produced in ArcGIS Pro using political boundary shapefiles from https://geodata.ucdavis.edu/gadm/gadm4.1/shp/gadm41_VNM_shp.zip. (TIFF)</p

Fig 5 -

Epidemiological distribution of human anthrax reported in Dien Bien province Vietnam from 2012–2018 by age (A), gender (B) and source of infection (C).</p

Fig 4 -

Annual trend of anthrax in human (A) and livestock (B) at provincial level and contribution of each district to the trends (2010–2018), Dien Bien province, Vietnam.</p