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

Behavior-based swarm model using fuzzy controller for route planning and E-waste collection

Nowadays, because of the increase in consumption of electronic equipment and its resource utilization, household e-waste has been generated gradually. The increase in e-waste generation brought environmental burdens as well as a health risk in several nations. The disposal of e-waste in landfills is not recommended due to some poisonous and contaminated chemicals. The improper collection of e-waste leads to a negative impact on human health and also causes air pollution, as well as the long-term effects on the environment. To address such issues, the behavior-based swarm model using a fuzzy controller (BSFC) is proposed for efficient e-waste collection. The proposed algorithm is employed to solve the problem based on routing associated with the time window for the heterogeneous fleet of the e-waste collection vehicle. The approach is provided for the online system that enables the people to request for the collection of e-waste components and also to solve the vehicle’s routing problem. The optimization result demonstrates the decrease in the collection cost and also the on-time e-waste collection from the household. The method comprises the implementation of e-waste collection requests in China and India for several urban arrangements of buildings and streets. The proposed approach fetches considerable enhancement in vehicle routing plans for the e-waste collection, counting the positive social impacts for the waste collection, particularly in urban regions

Solving Systems of Linear Fractional Integro-Differential Equations with Delay using Least Squares Method and Chebyshev Polynomials

In this paper, a numerical scheme is introduced for solving a linear system of fractional delay integro-differential equations (FDIDEs). The fractional derivative is considered in the Caputo sense. The spectral least squares method with the aid of the first kind Chebyshev polynomials was introduced to treat the proposed systems. The suggested method reduces this type of system to the solution of a block system of linear algebraic equations. To demonstrate the accuracy and applicability of the presented method some test examples are provided. Numerical results show that this approach is easy to implement and accurate when applied to the proposed system of FDIDEs

Structural and optical properties of ZnO thin film prepared by sol-gel spin coating

Zinc oxide (ZnO) thin films were deposited on Si (1 0 0) and glass substrates by sol-gel spin coating technique. Zinc acetate dihydrate, monoethanolamine and isopropanol were used as the sources for precursor solution and the resulting gel was used for the preparation of ZnO thin films. The films were annealed at different temperatures (100 °C to 500 °C) and the effect of annealing on the structural and optical properties was investigated. X-ray diffraction (XRD) and UV-Vis spectroscopy were used for the analysis of the films. The XRD results indicated the polycrystalline hexagonal structure of the ZnO films with (0 0 2) orientation. The optical properties of the films were studied using UV-Vis spectrophotometer in the wavelength range of 190 – 1100 nm. The optical characterization of the ZnO thin films showed the high transmittance of ~90 % for the films annealed at 400 °C. The films showed the absorbance ~360 – 390 nm and bandgap values of 3.40 – 3.10 eV, depending on the annealing temperature of the films

Double transition metal MXene (TixTa4−xC3) 2D materials as anodes for Li-ion batteries

Abstract A bi-metallic titanium–tantalum carbide MXene, TixTa(4−x)C3 is successfully prepared via etching of Al atoms from parent TixTa(4−x)AlC3 MAX phase for the first time. X-ray diffractometer and Raman spectroscopic analysis proved the crystalline phase evolution from the MAX phase to the lamellar MXene arrangements. Also, the X-ray photoelectron spectroscopy (XPS) study confirmed that the synthesized MXene is free from Al after hydro fluoric acid (HF) etching process as well as partial oxidation of Ti and Ta. Moreover, the FE-SEM and TEM characterizations demonstrate the exfoliation process tailored by the TixTa(4−x)C3 MXene after the Al atoms from its corresponding MAX TixTa(4−x)AlC3 phase, promoting its structural delamination with an expanded interlayer d-spacing, which can allow an effective reversible Li-ion storage. The lamellar TixTa(4−x)C3 MXene demonstrated a reversible specific discharge capacity of 459 mAhg−1 at an applied C-rate of 0.5 °C with a capacity retention of 97% over 200 cycles. An excellent electrochemical redox performance is attributed to the formation of a stable, promising bi-metallic MXene material, which stores Li-ions on the surface of its layers. Furthermore, the TixTa(4−x)C3 MXene anode demonstrate a high rate capability as a result of its good electron and Li-ion transport, suggesting that it is a promising candidate as Li-ion anode material