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

Early Wildfire Smoke Detection Using Different YOLO Models

Forest fires are a serious ecological concern, and smoke is an early warning indicator. Early smoke images barely capture a tiny portion of the total smoke. Because of the irregular nature of smoke’s dispersion and the dynamic nature of the surrounding environment, smoke identification is complicated by minor pixel-based traits. This study presents a new framework that decreases the sensitivity of various YOLO detection models. Additionally, we compare the detection performance and speed of different YOLO models such as YOLOv3, YOLOv5, and YOLOv7 with prior ones such as Fast R-CNN and Faster R-CNN. Moreover, we follow the use of a collected dataset that describes three distinct detection areas, namely close, medium, and far distance, to identify the detection model’s ability to recognize smoke targets correctly. Our model outperforms the gold-standard detection method on a multi-oriented dataset for detecting forest smoke by an mAP accuracy of 96.8% at an IoU of 0.5 using YOLOv5x. Additionally, the findings of the study show an extensive improvement in detection accuracy using several data-augmentation techniques. Moreover, YOLOv7 outperforms YOLOv3 with an mAP accuracy of 95%, compared to 94.8% using an SGD optimizer. Extensive research shows that the suggested method achieves significantly better results than the most advanced object-detection algorithms when used on smoke datasets from wildfires, while maintaining a satisfactory performance level in challenging environmental conditions

Early Wildfire Smoke Detection Using Different YOLO Models

Forest fires are a serious ecological concern, and smoke is an early warning indicator. Early smoke images barely capture a tiny portion of the total smoke. Because of the irregular nature of smoke’s dispersion and the dynamic nature of the surrounding environment, smoke identification is complicated by minor pixel-based traits. This study presents a new framework that decreases the sensitivity of various YOLO detection models. Additionally, we compare the detection performance and speed of different YOLO models such as YOLOv3, YOLOv5, and YOLOv7 with prior ones such as Fast R-CNN and Faster R-CNN. Moreover, we follow the use of a collected dataset that describes three distinct detection areas, namely close, medium, and far distance, to identify the detection model’s ability to recognize smoke targets correctly. Our model outperforms the gold-standard detection method on a multi-oriented dataset for detecting forest smoke by an mAP accuracy of 96.8% at an IoU of 0.5 using YOLOv5x. Additionally, the findings of the study show an extensive improvement in detection accuracy using several data-augmentation techniques. Moreover, YOLOv7 outperforms YOLOv3 with an mAP accuracy of 95%, compared to 94.8% using an SGD optimizer. Extensive research shows that the suggested method achieves significantly better results than the most advanced object-detection algorithms when used on smoke datasets from wildfires, while maintaining a satisfactory performance level in challenging environmental conditions

Tabular Data Generation to Improve Classification of Liver Disease Diagnosis

Liver diseases are among the most common diseases worldwide. Because of the high incidence and high mortality rate, these diseases diagnoses are vital. Several elements harm the liver. For instance, obesity, undiagnosed hepatitis infection, and alcohol abuse. This causes abnormal nerve function, bloody coughing or vomiting, insufficient kidney function, hepatic failure, jaundice, and liver encephalopathy.. The diagnosis of this disease is very expensive and complex. Therefore, this work aims to assess the performance of various machine learning algorithms at decreasing the cost of predictive diagnoses of chronic liver disease. In this study, five machine learning algorithms were employed: Logistic Regression, K-Nearest Neighbor, Decision Tree, Support Vector Machine, and Artificial Neural Network (ANN) algorithm. In this work, we examined the effects of the increased prediction accuracy of Generative Adversarial Networks (GANs) and the synthetic minority oversampling technique (SMOTE). Generative opponents’ networks (GANs) are a mechanism to produce artificial data with a distribution close to real data distribution. This is achieved by training two different networks: the generator, which seeks to produce new and real samples, and the discriminator, which classifies the augmented samples using supervised classifications. Statistics show that the use of increased data slightly improves the performance of the classifier

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population