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

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

The impact of political treaties and domestic and regional events on wood trade (A case study of Iran, Russia and the Warsaw Pact countries)

International trade has a significant share of the global economy; the issue of regulating foreign economic relations is a major contributor to political talks in the countries. Social, political and cultural events, including political and economic agreements, have a tremendous impact on the trade of countries. Forests around the world produce large amounts of wood and trade in products throughout the world. Since Iran has been trading in wood with Russia and other European countries about 100 years ago, this study was aimed at investigating the effects of political events on the bilateral exports of timber in Iran and Russia, as well as the effect of the Warsaw Treaty and its collapse on The wood trade of member countries with Iran was done using the gravity pattern. The results of the study show that the Warsaw Pact as a political treaty affects the trade relations of the countries of the covenant with Iran, and the per capita income of two trade partners, exchange rate changes and geographical distances on the volume of wood trade and Wood products have been effective. Results for both Iran and Russia show the impact of wood trade on political events as well as domestic laws and bills approved by the two countries

Comparison of Eight Weeks of Training in the Water and Land on Changes in Lumbar Lordosis of Girl Students of Yazd City

Introduction: Injuries related to lordosis 30 to 40 percent of spinal disorders have been allocated that the economic aspects of health care has also attracted attention. The aim of the present study was comparison of effect of eight weeks training in dry and water on change in lordosis of female students in Yazd. Materials and Methods: In this research 42 girls with lordosis in 9 to 12 years old were randomly selected from schools in Yazd and randomly divided into three groups of training in water (14 cases), land (n=14) and control group (14 people). Training program participants for eight weeks was carried out. Subject's lordosis was measured by flexible ruler as a noninvasive and reliable method of exercise before and after eight weeks. Repeated measures method was used for data analysis of pre-test and post-test. Results: The findings show that training on land and water had a positive effect on improving participant’s lordosis (P≤/05), but there was no significant difference in lordosis correction between two study groups (P≥/05). Conclusion: According to the results, both on land and water corrective exercise program for girls with lumbar lordosis is useful and there was no difference between the two programs in the reduction of lumbar lordosis. It is recommended that the land and water exercises for people with lumbar lordosis given, and each of these methods has its own specific characteristics which, according to experts identify the persons recommended.Keywords: Lordosis, Exercise on Land and Water, Corrective Exercise

Bare-Bones Based Salp Swarm Algorithm for Text Document Clustering

Text Document Clustering (TDC) is a challenging optimization problem in unsupervised machine learning and text mining. The Salp Swarm Algorithm (SSA) has been found to be effective in solving complex optimization problems. However, the SSA’s exploitation phase requires improvement to solve the TDC problem effectively. In this paper, we propose a new approach, known as the Bare-Bones Salp Swarm Algorithm (BBSSA), which leverages Gaussian search equations, inverse hyperbolic cosine control strategies, and greedy selection techniques to create new individuals and guide the population towards solving the TDC problem. We evaluated the performance of the BBSSA on six benchmark datasets from the text clustering domain and six scientific papers datasets extracted from the top eight UAE universities. The experimental results demonstrate that the BBSSA algorithm outperforms traditional SSA and nine other optimization algorithms. Furthermore, the BBSSA algorithm achieves better results than the five traditional clustering techniques