Is detecting oral cancer in general dental practices a realistic expectation? A population-based study using population linked data in Scotland

Introduction: Despite the increasing burden of oral cancer (OC) – including oral cavity (OCC) and oropharyngeal cancer (OPC) – it remains a relatively low-volume disease in Scotland, with anecdotal evidence suggesting that dentists only see between one and two cases in their practising careers. Aims: To examine, for the first time on a population-basis via data linkage, whether early detection by general dental practices (GDP) is a realistic expectation by i) estimating the number of OC cases/year a dentist in Scotland may encounter over time, accounting for the deprivation level of practice location and dental registration/attendance rates, and ii) assessing whether patients attended GDPs two years pre-diagnosis. Materials and methods: Scottish Cancer Registry data on all OC cases (2010-2012), published NHS Scotland dental workforce and registration/participation statistics, and individual patient data linked with NHS dental service activity were analysed. Results: Dentists were estimated to potentially encounter one case of OC every 10 years, OCC every 16.7 years, and OPC every 25 years. However, 53.7% of OC patients had made no dental contact two years pre-diagnosis. Conclusion: Strategies for early detection must consider the rarity of OC incidence and poor dental attendance patterns. These results highlight the importance of improving access and uptake of dental services among those at highest risk to increase the opportunities for early detection

Know thy eHealth user: Development of biopsychosocial personas from a study of older adults with heart failure

BACKGROUND: Personas are a canonical user-centered design method increasingly used in health informatics research. Personas-empirically-derived user archetypes-can be used by eHealth designers to gain a robust understanding of their target end users such as patients. OBJECTIVE: To develop biopsychosocial personas of older patients with heart failure using quantitative analysis of survey data. METHOD: Data were collected using standardized surveys and medical record abstraction from 32 older adults with heart failure recently hospitalized for acute heart failure exacerbation. Hierarchical cluster analysis was performed on a final dataset of n=30. Nonparametric analyses were used to identify differences between clusters on 30 clustering variables and seven outcome variables. RESULTS: Six clusters were produced, ranging in size from two to eight patients per cluster. Clusters differed significantly on these biopsychosocial domains and subdomains: demographics (age, sex); medical status (comorbid diabetes); functional status (exhaustion, household work ability, hygiene care ability, physical ability); psychological status (depression, health literacy, numeracy); technology (Internet availability); healthcare system (visit by home healthcare, trust in providers); social context (informal caregiver support, cohabitation, marital status); and economic context (employment status). Tabular and narrative persona descriptions provide an easy reference guide for informatics designers. DISCUSSION: Personas development using approaches such as clustering of structured survey data is an important tool for health informatics professionals. We describe insights from our study of patients with heart failure, then recommend a generic ten-step personas development process. Methods strengths and limitations of the study and of personas development generally are discussed

Baroreflex Sensitivity is Impaired in Athletes Following a Sports-Related Concussion

Sport-related concussions are a major public health concern, with approximately 3.8 million incidences occurring annually in the United States alone. Autonomic nervous system (ANS) dysfunction is implicated in early and later stages of sports-related concussion recovery. Arterial baroreflex, a crucial mechanism by which the ANS controls short-term fluctuations in blood pressure, remains understudied in this population. PURPOSE: Examine baroreflex sensitivity (BRS) at rest during acute and sub-acute recovery phases following a sport-related concussion in collegiate athletes in comparison to non-injured athletes as controls. METHODS: Athletes (20±1 years) with sports-related concussions were tested on days 3 (N=13), 21 (N=13), and 90 (N=11) following the injury. Control athletes (N=12) were assessed at one time-point. Continuous arterial blood pressure (finger photoplethysmography) and R-R intervals (3-lead electrocardiogram) were obtained at rest for 6 minutes and while subjects were seated in an upright position. BRS was estimated with transfer function analysis to assess the fluctuations in systolic blood pressure and R-R intervals during the time period. Transfer gain in the low-frequency range (0.05– 0.15 Hz) quantified the magnitude of the relationship between changes in systolic blood pressure and R-R interval. Therefore, higher gain indicates higher BRS. A linear mixed model was used to examine symptoms and transfer function variables between the controls and the concussed athletes at the three time points. RESULTS: As anticipated, symptoms were worse on day-3 and resolved during the day-21 sub-acute phase. BRS was lower on day-3 (0.656±0.2U; p=0.003), day-21 (0.711±0.29U; p=0.013), and day-90 (0.77±0.27; p=0.04) following the injury compared to the controls (1.05±0.3U). CONCLUSION: The findings confirm impairments in baroreflex sensitivity during the acute and subacute recovery phases following a concussion despite symptom resolution. Blunted baroreflex sensitivity following injury may position athletes in a vulnerable situation while performing tasks that elicit sudden changes in blood pressure on and off the field

Interventions for sustainable surgery: a systematic review

Objective: To systematically evaluate interventions designed to improve the sustainability of surgical practice with respect to their environmental and financial impact. Background: Surgery contributes significantly to emissions attributed to healthcare due to its high resource and energy use. Several interventions across the operative pathway have, therefore, been trialed to minimize this impact. Few comparisons of the environmental and financial effects of these interventions exist. Materials and Methods: A search of studies published up to 2nd February 2022 describing interventions to increase surgical sustainability was undertaken. Articles regarding the environmental impact of only anesthetic agents were excluded. Data regarding environmental and financial outcomes were extracted with a quality assessment completed dependent upon study design. Results: 1162 articles were retrieved, of which 21 studies met inclusion criteria. 25 interventions were described, which were categorized into 5 domains: ‘reduce and rationalize’, ‘reusable equipment and textiles’, ‘recycling and waste segregation’, ‘anesthetic alternatives’ and ‘other’. 11/21 studies examined reusable devices; those demonstrating a benefit, reported 40-66% lower emissions than with single-use alternatives. In studies not showing a lower carbon footprint, reduction in manufacturing emissions were offset by the high environmental impact of local fossil-fuel based energy required for sterilization. The per use monetary cost of reusable equipment was 47-83% of the single-use equivalent. Conclusions: A narrow repertoire of interventions to improve the environmental sustainability of surgery has been trialed. The majority focus upon reusable equipment. Emissions and cost data is limited, with longitudinal impacts rarely investigated. Real-world appraisals will facilitate implementation, as will an understanding of how sustainability impacts surgical decision-making

Lithium-sulfur cell equivalent circuit network model parameterization and sensitivity analysis

Compared to lithium-ion batteries, lithium-sulfur (Li-S) batteries potentially offer greater specific energy density, a wider temperature range of operation, and safety benefits, making them a promising technology for energy storage systems especially in automotive and aerospace applications. Unlike lithium-ion batteries, there is not a mature discipline of equivalent circuit network (ECN) modelling for Li-S. In this study, ECN modelling is addressed using formal ‘system identification’ techniques. A Li-S cell’s performance is studied in the presence of different charge/discharge rates and temperature levels using precise experimental test equipment. Various ECN model structures are explored, considering the trade-offs between accuracy and speed. It was concluded that a ‘2RC’ model is generally a good compromise, giving good accuracy and speed. Model parameterization is repeated at various state-of-charge (SOC) and temperature levels, and the effects of these variables on Li-S cell’s ohmic resistance and total capacity are demonstrated. The results demonstrate that Li-S cell’s ohmic resistance has a highly nonlinear relationship with SOC with a break-point around 75% SOC that distinguishes it from other types of battery. Finally, an ECN model is proposed which uses SOC and temperature as inputs. A sensitivity analysis is performed to investigate the effect of SOC estimation error on the model’s accuracy. In this analysis, the battery model’s accuracy is evaluated at various SOC and temperature levels. The results demonstrate that the Li-S cell model has the most sensitivity to SOC estimation error around the break-point (around 75% SOC) whereas in the middle SOC range, from 20% to 70%, it has the least sensitivity

Electrocautery, diathermy, and surgical energy devices: are surgical teams at risk during the COVID-19 pandemic?

OBJECTIVE: The aim of the study was to provide a rapid synthesis of available data to identify the risk posed by utilizing surgical energy devices intraoperatively due to the generation of surgical smoke, an aerosol. Secondarily it aims to summarize methods to minimize potential risk to operating room staff. SUMMARY BACKGROUND DATA: Continuing operative practice during the coronavirus disease-19 (COVID-19) pandemic places the health of operating theatre staff at potential risk. SARS-CoV2 is transmitted through inhaled droplets and aerosol particles, thus posing an inhalation threat even at considerable distance. Surgical energy devices generate an aerosol of biological particular matter during use. The risk to healthcare staff through use of surgical energy devices is unknown. METHODS: This review was conducted utilizing a rapid review methodology to enable efficient generation and dissemination of information useful for concurrent clinical practice. RESULTS: There are conflicting stances on the use of energy devices and laparoscopy by different surgical governing bodies and societies. There is no definitive evidence that aerosol generated by energy devices may carry active SARS-CoV2 virus. However, investigations of other viruses have demonstrated aerosolization through energy devise use. Measures to reduce potential transmission include appropriate personal protective equipment, evacuation and filtration of surgical plume, limiting energy device use if appropriate, and adjusting endoscopic and laparoscopic practice (low CO2 pressures, evacuation through ultrafiltration systems). CONCLUSIONS: The risk of transmission of SARS-CoV2 through aerosolized surgical smoke associated with energy device use is not fully understood, however transmission is biologically plausible. Caution and appropriate measures to reduce risk to healthcare staff should be implemented when considering intraoperative use of energy devices

A MATLAB graphical user interface for battery design and simulation; from cell test data to real-world automotive simulation

This paper describes a graphical user interface (GUI) tool designed to support cell design and development of manufacturing processes for an automotive battery application. The GUI is built using the MATLAB environment and is able to load and analyze raw test data as its input. After data processing, a cell model is fitted to the experimental data using system identification techniques. The cell model's parameters (such as open-circuit-voltage and ohmic resistance) are displayed to the user as functions of state of charge, providing a visual understanding of the cell's characteristics. The GUI is also able to simulate the performance of a full battery pack consisting of a specified number of single cells using standard driving cycles and a generic electric vehicle model. After a simulation, the battery designer is able to see how well the vehicle would be able to follow the driving cycle using the tested cells. Although the GUI is developed for an automotive application, it could be extended to other applications as well. The GUI has been designed to be easily used by non-simulation experts (i.e. battery designers or electrochemists) and it is fully automated, only requiring the user to supply the location of raw test data

Reference performance test Methodology for degradation assessment of lithium-sulfur batteries

Lithium-Sulfur (Li-S) is an emerging battery technology receiving a growing amount of attention due to its potentially high gravimetric energy density, safety, and low production cost. However, there are still some obstacles preventing its swift commercialization. Li-S batteries are driven by different electrochemical processes than commonly used Lithium-ion batteries, which often results in very different behavior. Therefore, the testing and modeling of these systems have to be adjusted to reflect their unique behavior and to prevent possible bias. A methodology for a Reference Performance Test (RPT) for the Li-S batteries is proposed in this study to point out Li-S battery features and provide guidance to users how to deal with them and possible results into standardization. The proposed test methodology is demonstrated for 3.4 Ah Li-S cells aged under different conditions