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

Analyzing the Concept of Place Attachment In The Context of Spatial Factors: Kuzguncuk, Istanbul

In contemporary globalised cities it has become increasingly important, for those of us who live in monotonous so-called cloned-environments, to find a sense of place we can identify with. When ties between inhabitants and places are disrupted, people are estranged from their neighbourhoods. As a result, not only people's relations with places are harmed, but also their social relations are affected, leading to isolation, alienation and socio-economic disruption

Tax in tourism research: A bibliometric analysis

Tourism industry is one of the important sources in terms of tourism economy. For this reason, tourism and tax are two important variables. Tax in the field of tourism research and the usage areas of these taxes are other remarkable issues. In recent years, countries and many tourism businesses have been taking taxes from tourists for various expenditure items. The increasing importance of tax in terms of both supply and demand side, and the lack of a holistic comprehension of the knowledge domain in the literature are the motivation of the study. In this context, this study aimed to present a comprehensive evaluation by examining the scientific articles published about tax in tourism literature. Articles published between the years 2010 and 2022 in the tourism journals cited in the SSCI, SCI & ESCI indexes in the Web of Science (WOS), were examined with bibliometric analysis. It was concluded that the studies carried out in the determined area increased quantitatively in 2021. As keywords, tax and carbon & tourist tax come to the fore the most. Dynamic Computable General Equilibrium Model is the most used model. The results of the study suggest future research directions

Bacterial and archeal dynamics of a labscale HYBRID gas fermentation bioreactor fed with CO2 and H-2

###EgeUn###16s rDNA-based methods were used in order to identify the dynamics of microbial profiles in a HYBRID gas fermentation bio-methanization reactor. The effects of various H-2 and CO2 ratios on microbial community were investigated. The HYBRID gas fermentation reactor was composed of granular anaerobic seed and the system fed with only H-2 and CO2 gases. No additional organic material and trace element was fed during the throughout the experiments; thus, the microbial diversity was directly related to production of methane. The dynamics of the microbial communities were investigated with DGGE and real-time PCR analysis. The results showed that Methanobacteriales members were more dominated than Methanosarcinales and Methanomicrobiales members in the system. DGGE results indicated that Methanosaeta concilii, Methanoculleus sp., Methanosphaerula palustris, Methanofollis formosanus, Methanolinea sp., and Methanobacterium palustre were the most prominent methanogens depending on different H-2/CO2 ratios. DGGE profiles suggested that hydrogenotrophic and acetoclastic species were responsible for the production of methane. The survival of syntrophic bacteria and acetoclastic methanogens was attributed to their utilization of organic materials provided by lysis. To the best of our knowledge, this is the first microbial profile detection study in a hybrid bioreactor system operated with only pure hydrogen and carbon dioxide.Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [115Y455]; Ege University Scientific Research FundEge University [16/EBILTEM/003]The authors thank Scientific and Technological Research Council of Turkey (TUBITAK) under the grant no. 115Y455 for the financial support of this study. The authors also thank Ege University Scientific Research Fund under the grant no. 16/EBILTEM/003 for the financial support of this study

Comparative analysis of the effect of cell immobilization on the hydrogenothrophic biomethanation of CO2

WOS:000633496000001Carbon capture and utilization (CCU) has been offered as a potential technological solution for mitigating the greenhouse gas emissions and climate change concern worldwide. Anaerobically carbon utilization has started to be in the agenda of researchers in recent years since this approach offers significant advantages such as use of catalysis reactions through environmentally friendly microorganisms under low temperature and pressure operational conditions. Moreover, a cleaner and more effective bioenergy production is realized in the form of biomethane. This study aimed to exploit the merits of cell immobilization in order to provide a stable hydrogenotrophic biomethanation process. For this purpose, two different immobilized bioreactors packed with plastic moving bed biofilm reactor (MBBR) and glass beads packing materials were comparatively investigated. To the best of our knowledge, these two immobilization materials were used for the first time for this purpose. Two different bioreactor configurations were compared for the performance parameters such as methane formation rate, H-2 consumption and methane contents in the headspace. Methane content in the headspace of these bioreactors were measured to be 80 and 75% for MBBR bioreactor and glass bead bioreactors, respectively. in addition, methane formation rates (MFR) of 5.14 and 4.8 m(3)/m(3)/day were achieved in MBBR and glass beads bioreactors, respectively. Even though both bioreactor configurations performed highly efficient biomethanation of CO2, the statistical evaluation of the results indicated that MBBR performance was more favourable for hydrogenotrophic biomethanation. (c) 2021 Society of Chemical Industry and John Wiley & Sons, Ltd.Ege University Scientific Research Project FundEge University [17/CSUAM/002]The authors thank Ege University Scientific Research Project Fund for the financial support of this study under the Grant No 17/CSUAM/002 The authors also thank Aquaflex Company (Turkey) for the support of supplying bioaqua MBBR rings