In contemporary post‐operative pain management, patients are most often treated with combinations of non‐opioid analgesics, to enhance pain relief and to reduce opioid requirements and opioid‐related ...adverse effects. A diversity of combinations is currently employed in clinical practice, and no well‐documented ‘gold standards’ exist. The aim of the present topical, narrative review is to provide an update of the evidence for post‐operative analgesic efficacy with the most commonly used, systemic non‐opioid drugs, paracetamol, non‐steroidal anti‐inflammatory drugs (NSAIDs)/COX‐2 antagonists, glucocorticoids, gabapentinoids, and combinations of these. The review is based on data from previous systematic reviews with meta‐analyses, investigating effects of non‐opioid analgesics on pain, opioid‐requirements, and opioid‐related adverse effects. Paracetamol, NSAIDs, COX‐2 antagonists, and gabapentin reduced 24 h post‐operative morphine requirements with 6.3 (95% confidence interval: 3.7 to 9.0) mg, 10.2 (8.7, 11.7) mg, 10.9 (9.1, 12.8) mg, and ≥ 13 mg, respectively, when administered as monotherapy. The opioid‐sparing effect of glucocorticoids was less convincing, 2.33 (0.26, 4.39) mg morphine/24 h. Trials of pregabalin > 300 mg/day indicated a morphine‐sparing effect of 13.4 (4, 22.8) mg morphine/24 h. Notably, though, the available evidence for additive or synergistic effects of most combination regimens was sparse or lacking. Paracetamol, NSAIDs, selective COX‐2 antagonists, and gabapentin all seem to have well‐documented, clinically relevant analgesic properties. The analgesic effects of glucocorticoids and pregabalin await further clarification. Combination regimens are sparsely documented and should be further investigated in future studies.
Purpose
The study aims to describe work status at diagnosis and 8 years post-diagnosis in a nationwide sample of breast cancer survivors (BCSs), and investigate associated and self-reported factors ...of reduced work status.
Methods
Women aged 20–65 years when diagnosed with stage I–III breast cancer (BC) in 2011 or 2012 were invited to participate in a questionnaire study in 2019 (
n
= 2803), of whom 49% (
n
= 1361) responded. For this sub-study, we included 974 BCSs below the legal retirement age in Norway (< 67 years) at survey and with complete work status data. Reduced work status was defined as being in paid work at BC diagnosis and not working at time of survey. Logistic regression analyses were applied to identify factors associated with reduced work status.
Results
Of BCSs who were in paid work at diagnosis (
n
= 845), 63% maintained their work status to 8 years later. Reduced work status was associated with not living with children (OR .44, 95% CI .24–.82), age (OR 1.16, 95% CI 1.11–1.21), chemotherapy (OR 2.83, 95% CI 1.24–6.61), > 2 comorbid conditions (OR 2.27, 95% CI 1.16–4.32), cognitive function (OR .99, 95% CI .98–.99), fatigue (OR 1.02, 95% CI 1.01–1.03), and neuroticism (OR 1.57, 95% CI 1.00–2.46). BC and late effects were reported as reasons for reduced work status and disability.
Conclusions
The majority of BCSs who were in paid work at diagnosis were working 8 years later.
Implications for Cancer Survivors
Our results suggest a need to focus on fatigue and reduced cognitive function among long-term BCSs, with the ultimate aim of improving work sustainability.
Post‐operative pain affects millions of patients worldwide and the post‐operative period has high rates of morbidity and mortality. Some of this morbidity may be related to analgesics. The aim of ...this review was to provide an update of current knowledge of adverse events (AE) associated with the most common perioperative non‐opioid analgesics: paracetamol, non‐steroidal anti‐inflammatory drugs (NSAIDs), glucocorticoids (GCCs), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta‐analyses of analgesic efficacy and/or adverse effects of perioperative non‐opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post‐operative period. For paracetamol, the incidence of AEs appears trivial. Data are inconclusive regarding an association of NSAIDs with mortality, cardiovascular events, surgical bleeding and renal impairment. Anastomotic leakage may be associated with NSAID usage. No firm evidence exists for an association of NSAIDs with impaired bone healing. Single‐dose GCCs were not significantly related to increased infection rates or delayed wound healing. Gabapentinoid treatment was associated with increased sedation, dizziness and visual disturbances, but the clinical relevance needs clarification. Importantly, data on AEs of combinations of the above analgesics are sparse and inconclusive. Despite the potential adverse events associated with the most commonly applied non‐opioid analgesics, including their combinations, reporting of such events is sparse and confined to the immediate perioperative period. Knowledge of benefit and harm related to multimodal pain treatment is deficient and needs clarification in large trials with prolonged observation.
Ni and Ni2Al3 coatings were applied to superheater tubes that were built into a wood-fired boiler with an outlet steam temperature of 520 °C. The present paper evaluates the performance of the ...coatings after two years of service. The corrosion performance of the coatings is discussed with respect to the temperature histograms and deposit composition and compared to the performance of the coatings after the first year. The Ni coatings showed extremely protective behaviour for 1 year however after 2 years exposure, the Ni coating was chemically attacked, thick NiO was formed and sulphur containing precipitates were present at the base of the Ni layer indicating grain boundary ingress of corrosive species. For the Ni2Al3 coatings, localized attack was observed after the first year of exposure, but after two years no intact nickel aluminide coatings were observed.
•1 and 2 year exposure of Ni and Ni2Al3 coated superheater tubes in a biomass boiler with 520°C steam temperature•Ni coatings were protective for 1 yr but revealed oxidation, intergranular attack and metal sulphide formation after 2 yrs•Ni2-Al3 coatings were mainly protective after 1 year but suffered chemical degradation after 2 years•The differences from 1 to 2 years show the necessity for long-term plant exposures
Introduction
As the 5-year survival rate after breast cancer in Norway is 92%, the population of breast cancer survivors (BCSs) is increasing. Knowledge of work ability in this population is scarce. ...In a population-based cohort of BCSs, we explored work ability 8 years after diagnosis and the association between work ability and social support, and cancer-related variables including late effects and lifestyle factors.
Methods
In 2019, all Norwegian women < 59 years when diagnosed with stage I–III breast cancer in 2011 or 2012, were identified by the Cancer Registry of Norway and invited to participate in a survey on work life experiences. Work ability was assessed using the Work Ability Index (scale 0–10). Factors associated with excellent work ability (score ≥ 9) were identified using univariate and multivariate logistic regression analyses, and adjusted for socioeconomic-, health- and cancer-related variables.
Results
Of the 1951 eligible BCSs, 1007 (52.8%) responded. After excluding survivors with relapse (
n
= 1), missing information on work ability score (
n
= 49), or work status (
n
= 31), the final sample comprised 926 BCSs within working age at survey (< 67 years).
Mean age at survey was 56 years and 8 years (SD 0.7) had passed since diagnosis. Work ability had been reduced from 8.9 (SD 2.3) at diagnosis to 6.3 (SD 3.1). One in three BCSs reported poor work ability (WAS ≤ 5), and seven out of ten reported that their physical work ability had been reduced due to cancer. Social support from colleagues during cancer therapy was associated with excellent work ability, which was not observed for social support provided by supervisors or the general practitioner. Cognitive impairment and fatigue were inversely associated with work ability. None of the cancer-related variables, including treatment, were associated with work ability 8 years after diagnosis.
Conclusion
In this population-based sample, one in three BCSs reported poor work ability 8 years after diagnosis. Collegial social support during cancer therapy appears to be a protective factor for sustained work ability, whilst survivors struggling with fatigue and cognitive impairments may represent a particularly vulnerable group for reduced work ability.
A common cause for premature bearing failures in wind turbine gearboxes are the so-called White Etching Cracks (WEC). These undirected, three-dimensional cracks are bordered by regions of altered ...microstructure and ultimately lead to a cracking or spalling of the raceway. An accelerated WEC test was carried out on a FE8 test rig using cylindrical roller thrust bearings made of martensitic 100Cr6 steel. The resulting WECs were investigated with several characterisation techniques. Ultrasonic measurements showed the WEC were mainly located in the region of the overrolled surface in which negative slip occurs, which agrees with hypotheses based on an energetic approach for a prognosis. SEM orientation contrast imaging of the area around WEC revealed an inhomogeneous structure with varied grain sizes and a large amount of defects. Microstructure characterization around the WEA using EBSD showed significant grain refinement. Atom probe tomography showed the microstructure in the undamaged zone has a plate-like martensitic structure with carbides, while no carbides were detected in the WEA where the microstructure consisted of equiaxed 10nm grains. A three dimensional characterisation of WEC network was successfully demonstrated with X-ray computerized tomography, showing crack interaction with unidentified inclusion-like particles.
•Accelerated laboratory WEC test successfully carried out.•Electron backscatter diffraction of WEC region.•3D characterization of nanocrystalline WEA using atom probe tomography.•3D characterisation of WEC network using X-ray tomography.
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•In-plant testing of Ni2Al3 coated superheater tubes were performed in a biomass-firing power plant for one year.•In the protective areas, a 30–50 nm γ-Al2O3 layer was present on the ...surface and no Al depletion was observed below the oxide layer.•At locations with corrosion attack, no alumina scale was present and an amorphous K–O surface layer with a thickness of 200–250 nm was found.•γ-Al2O3 was broken down by reaction with KCl(g) resulting in potassium aluminate and volatile AlCl3 was formed by the migration of Cl.•A molten salt consisting of KCl-AlCl3 can lead to alumina fluxing and further penetration of corrosive species into the coating.
A Ni2Al3 coated tube was exposed in a wood firing power plant for 7100 h. The exposure resulted in protective behaviour in most areas, while corrosion attack occurred in local areas. In areas exhibiting protective behaviour, a 30−50 nm thick γ-Al2O3 layer was found, and a 200−250 nm K–O rich amorphous layer was identified in the corroded area. A corrosion mechanism is suggested: γ-Al2O3 was broken down by reaction with KCl(g) resulting in formation of potassium aluminate. Migration of Cl through potassium aluminate resulted in formation of volatile AlCl3. KCl-AlCl3 then led to alumina fluxing and further corrosion attack.
The structure and dynamic properties of poly(N-isopropylacrylamide) brushes at solid planar surfaces under good solvent conditions are studied. Polymer brushes with grafting densities in the ...concentrated and semidilute regime are prepared via surface-initiated atom transfer radical polymerization. The polymer brushes were removed from the substrates to determine the molar mass and molecular dispersity via size-exclusion chromatography to draw conclusions about the grafting density. The structure of the brushes was investigated with ellipsometry and neutron reflectometry measurements. We found an influence of the grafting density on the swelling properties of the poly(N-isopropylacrylamide) brushes. Furthermore, the brush dynamics at different neutron penetration depths was analyzed with neutron spin echo spectroscopy under grazing incidence. The evanescent intensity distribution was modeled with the BornAgain software package, which uses the distorted-wave Born approximation.
Pack cementation was used to produce Fe1−xAl and Fe2Al5 diffusion coatings on ferritic‐martensitic steel P91 and a Ni2Al3 diffusion coating on pure nickel. The performance of diffusion coatings ...against high‐temperature corrosion induced by potassium chloride (KCl) was evaluated by exposing the samples at 600 °C for 168 h in static lab air under KCl deposit. In addition, a salt‐free experiment was performed for comparison. Microstructure, chemical and phase composition of the samples were analyzed with scanning electron microscopy (SEM), energy dispersive X‐ray spectroscopy (EDS) and X‐ray diffractometry (XRD) before and after the exposures. It was found that all the diffusion coatings formed protective oxides under salt‐free exposure in air. Under the salt deposit, Fe1−xAl showed local failure while on large parts of the sample a protective layer had formed. Fe2Al5 was attacked over the entire surface and the dominant mode of attack was selective aluminum removal. Ni2Al3 showed excellent performance and no sign of attack was observed anywhere on the sample.
Pack cementation was used to produce Fe1−xAl and Fe2Al5 diffusion coatings on ferritic‐martensitic steel P91 and a Ni2Al3 diffusion coating on pure nickel. The performance of diffusion coatings against high temperature corrosion induced by KCl was evaluated by exposing the samples at 600 °C for 168 h in static lab air under KCl deposit. Ni2Al3 showed excellent performance and no sign of attack was observed anywhere on the sample.
The present paper addresses the experimental assessment of the concentration dependent nitrogen diffusion coefficient in stress free expanded austenite foils from thermogravimetry, the numerical ...simulation of nitrogen concentration depth profiles on growth of expanded austenite into stainless steel during gaseous nitriding, a qualitative discussion of the role of stress on local equilibrium conditions of growing expanded austenite and a discussion of the erroneous concentration dependent diffusivity of nitrogen in expanded austenite as obtained from applying the Boltzmann-Matano method to composition-depth profiles.
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