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

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Deposition at oblique angle and evolution of the structural-magnetic properties ofTa/Ru/Ta/Co40Fe40B20 multilayers

Deposition at Oblique Angle and Evolution of The Structural-Magnetic Properties of Ta/Ru/Ta/Co40Fe40B20 MultilayersM. Yıldırım, R. Mustafa Oksuzoglu*, S. Pekdemir, O. DenizDepartment of Materials Science and Engineering, Anadolu University, 26480, Eskisehir, [email protected] tunnel junctions (MTJs) with CoFeB electrodes are attractive for researchersworldwide due to its potential for rich physics and industrial applications due to their large tunnel magnetoresistance (TMR) at room temperature [1,2]. Such MTJs form the basis of the advanced magnetoresistive random access memories (MRAM) [3], non-volatile logics such as spin torque magnetic random access memories, and spin transfer torque (STT) nano-oscillator microwave sources [4-6]. One of the important properties for such classes of magnetic devices is high sensitivity, which is correlated with the coercivity and anisotropy of the CoFeB electrodes [7].Thus, the detailed understanding of the growth mechanism of MTJ systems and the interfacialevolution during deposition are extremely important for the performance improvement ofspintronics devices. Investigations of growth mechanism in the Ta/Ru/Ta/CoFeB based MLs, which were mostly deposited using the RF magnetron sputtering technique, is essential for the pseudospin- valve systems due to their desired magnetoresistance properties [1,2] and their potential applications in high density non-volatile memories [3]. However, no experimental proof exists up to now for growth mechanism of sputter deposited Ta/Ru/Ta/CoFeB Multilayers (MLs) and its relationship to magnetic properties.In the present study, the Ta/Ru/Ta/CoFeB/Ta MLs deposited at an oblique deposition angle using the Pulsed DC unbalanced magnetron sputtering technique have been investigated. Our purpose was to study the growth mechanism and evolution of the structure (texture, grain size, interface roughness, stress) and their correlation to magnetic properties. The X-ray-reflectivity and X-Ray diffraction measurements were used for determination of the growth mechanism and structural properties, whereas the anisotropy constants and coercive field were analyzed using the Vibration Sample Magnetometer. A strong (002) preferred orientation of the Ru layers, i.e., an &lt;002&gt; out-of plane texture, and evolutions of both grain size and interface roughness were observed in dependence on the Ru thickness. These properties are correlated with the evolution of the stress in MLs. The evolution of the in-plane anisotropy and coercivity and its relationship to growth mechanism and structural properties were discussed.[1] S. Ikeda, J. Hayakawa, Y. Ashizawa, Y. M. Lee, K. Miura, H. Hasegawa, M. Tsunoda, F. Matsukura, and H. Ohno, Appl. Phys. Lett. 93, 082508 (2008)[2] Lixian Jiang, Hiroshi Naganuma, Mikihiko Oogane, and Yasuo Ando Appl. Phys. Express. 2, 083002(2009).[3] Z. Diao, D. Apalkov, M. Pakala, Y. Ding, A. Panchula, and Y. Huai, Appl. Phys. Lett. 87, 232502 (2005).[4] A. Mochizuki, H. Kimura, M. Ibuki, and T. Hanyu, IEICE Trans. Fundamentals E88-A, 1408 (2005).[5] S. Ikeda, J. Hayakawa, Y. M. Lee, F. Matsukura, Y. Ohno, T. Hanyu, and H. Ohno, IEEE Trans. Electron Devices 54, 991 (2007).[6] A. M. Deac, A. Fukushima, H. Kubota, H. Maehara, Y. Suzuki, S. Yuasa, Y. Nagamine, K. Tsunekawa,D. D. Djayaprawira, and N. Watanabe, Nat. Phys. 4, 803 (2008).[7] D. D. Djayaprawira, K. Tsunekawa, M. Nagai, H. Maehara, S. Yamagata, N. Watanabe, S. Yuasa, Y.Suzuki, and K. Ando, Appl. Phys. Lett. 86, 092502 (2005).</div