Plasma Dynamics

Contains reports on three research projects.United States Atomic Energy Commission (Contract AT(30-1)-1842)United States Air Force, Air Force Cambridge Research Center, Air Research and Development Command (Contract AF19(604)-5992)National Science Foundation (Grant G-9330)Flight Accessories Laboratory, Wright-Patterson Air Force Base (WADD Contract AF33(616)-3984

Exergy analysis of incremental sheet forming

Research in the last 15 years has led to die-less incremental forming processes that are close to realization in an industrial setup. Whereas many studies have been carried out with the intention of investigating technical abilities and economic consequences, the ecological impact of incremental sheet forming (ISF) has not been studied so far. Using the concept of exergy analysis, two ISF technologies, namely single sided and double sided incremental forming, are investigated and compared to conventional forming and hydroforming. A second exergy analysis is carried out with the purpose of examining the environmental impact of different forming technologies from a supply chain perspective. Therefore, related upstream activities (die set production, aluminum sheet production and energy conversion and supply) are included into the exergy analysis. The entire supply chain is modeled with Matlab/Simulink. The results of both analyses suggest that ISF is environmentally advantageous for prototyping and small production runs.United States. Dept. of Energy (Award DE-EE0003460

Plasma Electronics

Contains reports on seventeen research projects.National Science Foundation (Grant GK-57)United States Atomic Energy Commission (Contract AT(30-1)-3285)United States Atomic Energy Commission under Contract AT(30-1)-322

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