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

Freezing Range, Melt Quality, and Hot Tearing in Al-Si Alloys

In this study, three different aluminum-silicon alloys (A356, A413, and A380) that have different solidification morphology and solidification ranges were examined with an aim to evaluate the hot tearing susceptibility. T-shape mold and Constrained Rod Casting (CRC) mold were used for the characterization. Reduced Pressure Test (RPT) was used to quantify the casting quality by measuring bifilm index. It was found that bifilm index and solidification range have an important role on the hot tearing formation. As it is known, bifilms can cause porosity and in this case, it was shown that porosity formed by bifilms decreased hot tearing tendency. As the freezing range of alloy increases, bifilms find the time to unravel that reduces hot tearing. However, for eutectic alloy (A413), due to zero freezing range, regardless of bifilm content, hot tearing was never observed. A380.1 alloy had the highest tendency for hot tearing due to having the highest freezing range among the alloys investigated in this work

The effects of degassing, grain refinement & Sr-addition on melt quality-hot tear sensitivity relationships in cast A380 aluminum alloy

Hot tearing tendency of A380 with various element additions (Sr, Sr + Ti, Ti, B and B + Sr) was investigated. Constrained rod casting (CRC) hot tearing test method was used to characterize the hot tearing sensitivity. Reduced pressure test (RPT) samples were produced from each condition and all trials were repeated three times. Number density of pores on the cross section of RPT samples was calculated via digital image processing and statistical analysis was carried out. Microstructure analysis was carried out to observe the effect of alloying elements. Hot torn cross sections were subjected to SEM analysis. It was found that in aluminum alloys, the most deleterious defects, bifilms that are the cause of many defects, play an important role in initiating the hot tearing during solidification. It is important to note that the shape, size and distribution of bifilms are too complex. They act as heterogeneous nucleation site for liquid to separate and thus increase hot tearing

Biometric layering with fingerprints: template security and privacy through multi-biometric template fusion

As biometric applications are gaining popularity, there is increased concern over the loss of privacy and potential misuse of biometric data held in central repositories. We present a biometric authentication framework that constructs a multi-biometric template by layering multiple biometrics of a user, such that it is difficult to separate the individual layers. Thus, the framework uses the biometrics of the user to conceal them among one another. The resulting biometric template is also cancelable if the system is implemented with cancelable biometrics, such as voice. We present a realization of this idea combining two or three different fingerprints of the user, using four different methods of template construction. Three of the methods use less and less information of the constituent biometrics, so as to lower the risk of leakage and cross-link rates. Results are evaluated on publicly available Finger Verification Championship (FVC) 2000, 2002 and NIST fingerprint databases. With the FVC databases, we obtain 2.1%, 3.9% and 3.4% Equal Error Rate on average using the three proposed methods, while the state-of-the-art commercial system achieves 1.9%. Furthermore, we show low cross-link rates under 63% under different scenarios, while genuine identification rates are 100%, with such a small gallery of 55 templates

Treatment of a chemical industry effluent by nanofiltration and reverse osmosis

Advanced filtration processes, namely nanofiltration (NO) and reverse osmosis (RO), can produce high-quality permeate from industrial effluents for a safe discharge or water reuse. In the present study, a biologically treated complex chemical industry wastewater was dead-end filtered through commercial NE and RO membranes. Dow Filmtec NF270, NE90, BW30 and SW30 membranes and Lewabrane RO B090 membrane were tested either separately or sequentially by NE followed by RO. Filtration through NF270 decreased chemical oxygen demand, color and conductivity from 202 mg/L, 222 Pt-Co and 10,150 mu S/cm to 110 mg/L, 46 Pt-Co and 5,700 mu S/cm, respectively. NE membrane mainly removed organic matter and divalent ions. RO membrane BW30 further removed these parameters as well as monovalent ions and thereby significantly decreased conductivity to 1,914 mu S/cm. A secondary BW30 further decreased conductivity to 582 mu S/cm for water reuse in industry. NE membranes served as pretreatment for RO membranes preventing fouling. Satisfactory membrane permeabilities were obtained as 2.2 LMH/bar for NF270 at 70% water recovery and 1.2 LMH/bar for the succeeding BW30 at 50% recovery at 15 bar filtration pressure. The study showed that sequential NE RO process can successfully produce reusable permeates from a biologically pretreated chemical industry effluent