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

Synthetic and application of a novel resin from waste foam packing for adsorption of Acid Orange 67 from aqueous solution

Abstract Background The type of dyes used in textile industries are synthetic dyes which are toxic and cause harm to the aquatic ecosystem; in this paper, adsorptive removal of dye Color Index Acid Orange 67 pollutant from aqueous solutions using a novel resin synthetic from waste foam packing was investigated using the batch method. Results The adsorbent was characterized by Fourier-transform infrared spectroscopy (FTIR), surface morphology, and zero surface charge. Batch adsorption studies were carried out under various parameters such as contact time, pH, initial dye concentration, adsorbent dosage, and solution temperature on the removal of AO67. Experimental isotherm data were analyzed using Langmuir, Freundlich, Dubinin–Radushkevich (D-R), and Temkin isotherm models, and the isotherm constants were calculated using linear regression analysis for the determination of the isotherm parameters which describe the adsorption process. The best fit was obtained by Langmuir model. A comparison of kinetic models applied to the adsorption of Acid Orange 67 (AO67) onto resin polystyrene foam (RPSF) was evaluated for the pseudo-first-order, the pseudo-second-order, Elovich, intraparticle diffusion, and Bangham’s kinetics models. The adsorption kinetic data were properly fitted very well with the pseudo-second-order kinetic model. The thermodynamic parameters and activation energy were evaluated. Conclusion The results have established good potentiality for the RPSF to be used as an adsorbent for the removal of AO67 from aqueous solutions. The optimum conditions attained in this study were used for removal of (RB222, RY145, and AR37) from the simulated wastewaters onto RPSF

Responses of Pea (<i>Pisum sativum</i> L.) to Single and Consortium Bio-Fertilizers in Clay and Newly Reclaimed Soils

The huge development of climatic change highly affects our crop production and soil fertility. Also, the rise in the uncontrolled, excessive use of chemical fertilizers diminishes the soil prosperity and generates pollutants, threatening all environmental life forms, including us. Replacement of these chemical fertilizers with natural ones is becoming an inevitable environmental strategy. In our study, we evaluated the responses of Pisum sativum L. to the action of single species and consortiums of plant growth-promoting bacteria (Azotobacter chroococcum, Bacillus megaterium, and Bacillus cerkularice) in clay and new reclaimed soil types in terms of phenotype, yield components, and physiological and biochemical responses. Data analysis showed single or consortium microbial inoculation significantly increased the measured traits under clay and calcareous sandy soils compared to the control. Shoot physiological and biochemical activities, and seed biochemical activities were significantly enhanced with the inoculation of pea seeds with three types of bacteria in both soil types. The bud numbers, fresh weight, and seeds’ dry weight increased in seeds treated with A. chroococcum and B. megaterium in the sandy soil. Taken together, these findings suggested that the inoculation of plants with PGP bacteria could be used to diminish the implementation of chemical fertilizer and improve the goodness of agricultural products. These findings expand the understanding of the responsive mechanism of microbial inoculation under different soil types, especially at physiological and biochemical levels

Investigating the Impact of Economic Uncertainty on Optimal Sizing of Grid-Independent Hybrid Renewable Energy Systems

One of the many barriers to decarbonization and decentralization of the energy sector in developing countries is the economic uncertainty. As such, this study scrutinizes economics of three grid-independent hybrid renewable-based systems proposed to co-generate electricity and heat for a small-scale load. Accordingly, the under-study systems are simulated and optimized with the aid of HOMER Pro software. Here, a 20-year average value of discount and inflation rates is deemed a benchmark case. The techno-economic-environmental and reliability results suggest a standalone solar/wind/electrolyzer/hydrogen-based fuel cell integrated with a hydrogen-based boiler system is the best alternative. Moreover, to ascertain the impact of economic uncertainty on optimal unit sizing of the nominated model, the fluctuations of the nominal discount rate and inflation, respectively, constitute within the range of 15–20% and 10–26%. The findings of economic uncertainty analysis imply that total net present cost (TNPC) fluctuates around the benchmark value symmetrically between $478,704 and$814,905. Levelized energy cost varies from an amount 69% less than the benchmark value up to two-fold of that. Furthermore, photovoltaic (PV) optimal size starts from a value 23% less than the benchmark case and rises up to 55% more. The corresponding figures for wind turbine (WT) are, respectively, 21% and 29%. Eventually, several practical policies are introduced to cope with economic uncertainty

Techno-Economic Assessment of a Grid-Independent Hybrid Power Plant for Co-Supplying a Remote Micro-Community with Electricity and Hydrogen

This study investigates the techno-economic feasibility of an off-grid integrated solar/wind/hydrokinetic plant to co-generate electricity and hydrogen for a remote micro-community. In addition to the techno-economic viability assessment of the proposed system via HOMER (hybrid optimization of multiple energy resources), a sensitivity analysis is conducted to ascertain the impact of ±10% fluctuations in wind speed, solar radiation, temperature, and water velocity on annual electric production, unmet electricity load, LCOE (levelized cost of electricity), and NPC (net present cost). For this, a far-off village with 15 households is selected as the case study. The results reveal that the NPC, LCOE, and LCOH (levelized cost of hydrogen) of the system are equal to $333,074, 0.1155$/kWh, and 4.59 $/kg, respectively. Technical analysis indicates that the PV system with the rated capacity of 40 kW accounts for 43.7% of total electricity generation. This portion for the wind turbine and the hydrokinetic turbine with nominal capacities of 10 kW and 20 kW equates to 23.6% and 32.6%, respectively. Finally, the results of sensitivity assessment show that among the four variables only a +10% fluctuation in water velocity causes a 20% decline in NPC and LCOE

Preliminary Phytochemical and Biological Screening of Cyclamen coum a Member of Palestinian Flora

Background: Since ancient times, the treatment of various diseases has relied on medicinal plants. The replacement of chemically synthesized drugs with natural medications gave the later advantageous due to their safety for humans. This study aimed to screen and to evaluate preliminarily phytoconstituents, total contents of flavonoids, tannins, and phenols also to evaluate the antibacterial and antioxidant activities of Cyclamen coum aerial parts methanol extract. Methods: Screening of phytoconstituents, total flavonoids, tannins and phenols contents, as well as antioxidant properties, were investigated for the Cyclamen coum aerial parts by using standard phytochemical and analytical methods. Evaluation of antibacterial activity of the plant methanolic extract was performed by using broth microdilution method. American Type Culture Collections of Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus (MRSA) were utilized to evaluate antibacterial activity. Results: Preliminary phytochemical qualitative analysis of the plant methanolic extract showed that the plant aerial parts contained amino acids, reducing sugar, carbohydrate, tannin, flavonoid, phenol, saponin, cardiac glycoside, and steroids. Total flavonoids, phenols, and tannins in plant methanolic extract were 60.88 mg QUE/g, 32.7 mg GAE/g and 11.7 mg CAE/g, respectively. Meanwhile, the antioxidant activity was estimated to be 31 µg/mL and has very weak antibacterial activity on the studied pathogens. Conclusion: In the present study, evaluation of total phenolic, tannins and flavonoid content from the aerial parts of C. coum can be an antioxidant naturally potent source. The results of in-vitro antibacterial studies showed that the studied plant has very weak antibacterial activity. In addition, the presence of antioxidant compounds in C. coum makes it a good candidate for manufacturing dietary supplements and food preservative