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

X-Ray Photoelectron Spectroscopy Depth Profiling of As-Grown and Annealed Titanium Nitride Thin Films

Titanium nitride thin films were grown on Si(001) and fused silica substrates by radio frequency reactive magnetron sputtering. Post-growth annealing of the films was performed at different temperatures from 300 °C to 700 °C in nitrogen ambient. Films annealed at temperatures above 300 °C exhibit higher surface roughness, smaller grain size and better crystallinity compared to the as-grown film. Bandgap of the films decreased with the increase in the annealing temperature. Hall effect measurements revealed that all the films exhibit n-type conductivity and had high carrier concentration, which also increased slightly with the increase in the annealing temperature. A detailed depth profile study of the chemical composition of the film was performed by x-ray photoelectron spectroscopy confirming the formation of Ti-N bond and revealing the presence of chemisorbed oxygen in the films. Annealing in nitrogen ambient results in increased nitrogen vacancies and non-stoichiometric TiN films

X-Ray Photoelectron Spectroscopy Depth Profiling of As-Grown and Annealed Titanium Nitride Thin Films

Titanium nitride thin films were grown on Si(001) and fused silica substrates by radio frequency reactive magnetron sputtering. Post-growth annealing of the films was performed at different temperatures from 300 °C to 700 °C in nitrogen ambient. Films annealed at temperatures above 300 °C exhibit higher surface roughness, smaller grain size and better crystallinity compared to the as-grown film. Bandgap of the films decreased with the increase in the annealing temperature. Hall effect measurements revealed that all the films exhibit n-type conductivity and had high carrier concentration, which also increased slightly with the increase in the annealing temperature. A detailed depth profile study of the chemical composition of the film was performed by x-ray photoelectron spectroscopy confirming the formation of Ti-N bond and revealing the presence of chemisorbed oxygen in the films. Annealing in nitrogen ambient results in increased nitrogen vacancies and non-stoichiometric TiN films

[Promoting research competence in psychosocial medicine - A new curriculum for medical students]

Promoting research competence in psychosocial medicine - A new curriculum for medical students Objectives: The objective of this study is the introduction and evaluation of a new graduate-students curriculum to enhance research competence in psychosocial medicine. Method: N = 57 students have participated in the curriculum to date. All participants completed questionnaires regarding teaching quality and pre-post changes in subjective research competence. Results: All items on teaching quality were scored significantly higher (p < 0.05) compared to data of three other comparable psychosocial seminars. In addition, a substantial increase in subjective research competence was found (p < 0.05). Conclusions: The presented curriculum provides an opportunity to strengthen research competence and evidence-based critical thinking of prospective physicians at an early stage. As a consequence of these encouraging results, the curriculum has been implemented permanently at the medical faculty in Heidelberg

Curve Tilting With Nonlinear Model Predictive Control for Enhancing Motion Comfort

The benefits of automated driving can only be fully realized if the occupants are protected from motion sickness. Active suspensions hold the potential to raise the comfort level in automated passenger vehicles by enabling new functionalities in chassis control. One example is to actively lean the vehicle body toward the center of the corner to counteract the inertial lateral acceleration. Commonly known as curve tilting, the concept is deemed effective in reducing postural disturbance on the occupants and the visual-vestibular conflict when the occupants do not have an external view. We present in this article a nonlinear model predictive control (NMPC) method for the curve tilting functionality. The controller incorporates the nonlinear suspension forces in the prediction model to help achieve high tracking accuracy near the physical limit of the suspension system. The optimization process is accelerated with an explicit initialization method that is based on piecewise-affine (PWA) modeling and offline solution to an alternative optimal control problem (OCP). The controller is able to operate at 20 Hz in a hardware-in-the-loop (HIL) setup. Given sufficient computational resources, we observe a significant reduction in the lateral acceleration sensed by the passenger over a vehicle with passive suspensions, namely, by 46.5%, 25.4%, and 25.4% in the highway, rural, and urban driving scenarios, respectively. The NMPC also outperforms the baseline proportional-integral-derivative (PID) controller by achieving lower tracking error, namely, by 12.9%, 16.4%, and 38.0% in the aforementioned scenarios.Intelligent VehiclesTeam Tamas Keviczk

Fruchtkoerperentwicklung von hoeheren Basidiomyceten unter dem Einfluss der Schwerelosigkeit (D-2-Mission) Abschlussbericht

Contrary to corresponding investigations in higher plants, little is know on the physiological bases of gravitropism and gravimorphogenesis in fungi. The two and a half year research period provided important new insights in this field. This experiment during the D-2 space mission had the aim to measure changes in the cellular organization of the hyphes of fungus fruit bodies under microgravity conditions and influences of microgravity on the morphogenesis of the fruit bodies. (orig./HM)SIGLEAvailable from TIB Hannover: F94B1594 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDeutsche Agentur fuer Raumfahrtangelegenheiten (DARA) GmbH, Bonn (Germany); Bundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Characterization of supercapacitors matrix

International audienceThis paper treats supercapacitors matrix characterization. In order to cut off transient power peaks and to compensate for the intrinsic limitations in embedded sources, the use of supercapacitors as a storage system is quite suitable, because of their appropriate electrical characteristics (huge capacitance, small series resistance, high specific energy, high specific power), direct storage (energy ready for use), and easy control by power electronic conversion. This use requires supercapacitors modules where several cells connected in serial and/or in parallel, thus a bypass system to balance the charging or the discharging of supercapacitors is required. In the matrix of supercapacitors, six elements of three parallel BCAP0350 supercapacitors in serial connections have been considered. This topology permits to reduce the number of the bypass circuits and it can work in degraded mode. Actually, it allows the system to have more reliability by providing power continually to the load even when there are one or more cells failed. Simulation and experimental results are presented and discussed

Islamic economics: a survey of the literature

A central thesis of this paper is that social science is the study of human experience, and hence is strongly conditioned by history. Modern Western political, economic and social structures have emerged as a consequence of the repudiation of religion associated with the Enlightenment and are based on secular principles. Many of these are inimical to Islamic principles, and cannot be adapted to an Islamic society. Muslim societies achieved freedom from colonial rule in the first half of the twentieth century and have sought to construct institutions in conformity with Islam. The development of Islamic economics is part of this process of transition away from Western colonial institutions. This paper is a survey of the literature on Islamic economics, which focuses on the contrasts between Western economic theories and Islamic approaches to the organization of economic affairs