Head and Neck Injuries and Electronic Scooter Use in the United States

OBJECTIVE: To quantify electric scooter injuries encountered in United States emergency departments, focusing on the head and neck, to understand the safety impact of these scooters to improve safe usage. STUDY DESIGN: Retrospective cross-sectional study from January 2009 to December 2019 of patients presenting to United States emergency departments with electric scooter injuries collected from a national database. About 2,823 cases of injuries were related to electric scooter use from January 2009 to December 2019. Stratified weighted counts and incidence rates were estimated for injury characteristics. Piecewise linear regression quantified the yearly change in incidence of injuries before and after introduction of rideshare programs. RESULTS: The estimated national total of electric scooter cases from 2009 to 2019 was 103,943 (95% CI: 79,650-128,237). Incidence grew in 2019 to 8.63 cases per 100,000 person-years from 4.46 in 2018 to 2.42 in 2017. Head and neck injuries represented 28.5% of total injuries (weighted estimate = 29,610). The most common age group of head and neck injuries before 2018 was ≤17 years, but injuries in 18- to 44-year-olds grew significantly to become the most injured group in 2018 to 2019 (P \u3c .001). From 2009 to 2017, incidence of head and neck injuries fell by 0.02 cases per 100,000 person-years, but cases grew by 1.22 cases per 100,000 person-years post-2017 (P \u3c .001). CONCLUSION: Injuries following the launch of rideshare electric scooter programs increased significantly, especially in patients 18 to 44 years of age. Head and neck injuries represent many of these injuries. User safety education must be addressed to prevent injury as programs become more pervasive in the United States. LEVEL OF EVIDENCE: Level 2 Laryngoscope, 2021

The Development of System Identification Approaches for Complex Haptic Devices and Modelling Virtual Effects Using Fuzzy Logic

Haptic applications often employ devices with many degrees of freedom in order to allow the user to have natural movement during human-machine interaction. From the development point of view, the complexity in mechanical dynamics imposes a lot of challenges in modelling the behaviour of the device. Traditional system identification methods for nonlinear systems are often computationally expensive. Moreover, current research on using neural network approaches disconnect the physical device dynamics with the identification process. This thesis proposes a different approach to system identification of complex haptic devices when analytical models are formulated. It organizes the unknowns to be identified based on the governing dynamic equations of the device and reduces the cost of computation. All the experimental work is done with the Freedom 6S, a haptic device with input and feedback in positions and velocities for all 6 degrees of freedom . Once a symbolic model is developed, a subset of the overall dynamic equations describing selected joint(s) of the haptic robot can be obtained. The advantage of being able to describe the selected joint(s) is that when other non-selected joints are physically fixed or locked up, it mathematically simplifies the subset dynamic equation. Hence, a reduced set of unknowns (e. g. mass, centroid location, inertia, friction, etc) resulting from the simplified subset equation describes the dynamic of the selected joint(s) at a given mechanical orientation of the robot. By studying the subset equations describing the joints, a locking sequence of joints can be determined to minimize the number of unknowns to be determined at a time. All the unknowns of the system can be systematically determined by locking selected joint(s) of the device following this locking sequence. Two system identification methods are proposed: Method of Isolated Joint and Method of Coupling Joints. Simulation results confirm that the latter approach is able to successfully identify the system unknowns of Freedom 6S. Both open-loop experimental tests and close-loop verification comparison between the measured and simulated results are presented. Once the haptic device is modelled, fuzzy logic is used to address chattering phenomenon common to strong virtual effects. In this work, a virtual wall is used to demonstrate this approach. The fuzzy controller design is discussed and experimental comparison between the performance of using a proportional-derivative gain controller and the designed fuzzy controller is presented. The fuzzy controller is able to outperform the traditional controller, eliminating the need for hardware upgrades for improved haptic performance. Summary of results and conclusions are included along with suggested future work to be done

Sex Differences in Health Related Quality of Life in Head & Neck Cancer One Year After Treatment

Background: Head and neck cancer (HNC) makes up about 3% of all cancers and is treated with systemic therapy, radiation, surgery, or a combination of these. HNC treatment can be associated with decreased patient reported health related quality of life (HR-QoL), which can lead to depression. The majority of studies found that females reported worse patient reported HR-QoL than males, however, there were a few that did not have a significant difference in overall patient reported QoL. With the discovery of patient oriented outcomes (PROs) in clinical practice affecting patient satisfaction, provider-patient relationship, and overall patient mortality, it is vital to include PROs in the creation of treatment plans. Objectives: The objectives of this project are to highlight the differences in HR-QoL between men and women. Ultimately, using these PROs clinically will help to improve patient care, augment patient-provider trust, and optimize treatment plans. Using PROs and recognizing where unconscious biases of providers come into play is pinnacle, and this project aims to highlight how men and women\u27s experiences are different in the treatment of HNC. Methods: Participants were given the FACT-H&N instrument one year after treatment for head and neck cancer at a single tertiary academic center to assess different aspects of Hr-QoL. Sex differences were analyzed between the groups. A Wilcoxon Rank Sum test was performed to assess associations with sex and survey responses, as well as to assess associations with total laryngectomy and survey responses. Results: There were 100 participants from a single academic center of which 73% were men and 27% women. Several of the questions had significant differences between men and women: I feel ill (P=0.0299), I am satisfied with my family communication about my illness P=0.0075), I am satisfied with my sex life (P=0.0496), My voice has its usual quality and strength (P=0.0057), I can swallow naturally and easily (P=0.0437), and I can eat solid foods (P=0.0248). There were no significant differences between men and women with laryngectomies. Conclusions: Overall, men felt more ill, were less satisfied with their sex lives, were less likely to feel a normal strength and quality of voice, felt decreased ability to swallow normally, and felt they could not eat solid foods; women were less satisfied with communication about their disease to their families. For those who had undergone laryngectomy, there were no significant differences between men and women. Different aspects of quality of life for men and women are affected by head and neck cancer. Monitoring PROs are becoming increasingly standard of care for patients, and providers need to be equipped understand how to interpret data accordingly and understand the inherent biases

Antimicrobial resistance control activities at a tertiary hospital in a low-resource setting: an example of Queen Elizabeth Central Hospital in Malawi

BackgroundAddressing AMR has been most problematic in low- and middle-income countries, which lack infrastructure, diagnostic capacity, and robust data management systems, among other factors. The implementation of locally-led efforts in a low-income country to develop sustainability and build capacity for AMR control within the existing infrastructure has not been well documented.MethodsWe detail current AMR control initiatives at Queen Elizabeth Central Hospital, a tertiary referral government hospital in Malawi with limited resources, and present the activities accomplished to date, lessons learned, and challenges ahead.ResultsThe key areas of AMR control initiatives that the group focused on included laboratory diagnostics and surveillance, antimicrobial stewardship, infection prevention and control, pharmacy, leadership, education, and funding.DiscussionThe hospital AMR Control Working Group increased awareness, built capacity, and implemented activities around AMR control throughout the hospital, in spite of the resource limitations in this setting. Our results are based on the substantial leadership provided by the working group and committed stakeholders who have taken ownership of this process.ConclusionLimited resources pose a challenge to the implementation of AMR control activities in low- and middle-income countries. Leadership is central to implementation. Future efforts will need to transition the initiative from an almost fully personal commitment to one with wider engagement to ensure sustainability

Disparities in the Uptake of Telemedicine During the COVID-19 Surge in a Multidisciplinary Head and Neck Cancer Population by Patient Demographic Characteristics and Socioeconomic Status

This cohort study examines the association between patient demographic characteristics and socioeconomic status and engagement in telemedicine during the COVID-19 pandemic

Nature connection and wellbeing in children and adolescents: A systematic review and meta-analysis

Alexia Barrable - ORCID: 0000-0002-5352-8330 https://orcid.org/0000-0002-5352-8330Nature connection (also referred to as nature connectedness, connectedness to nature connection to nature, or nature relatedness) describes a positive relationship between humans and the natural world, with various benefits for both nature and humans. The latter include a small but robust positive correlation of nature connection with various types of wellbeing and flourishing. However, this correlation has been investigated meta-analytically in adults only; no meta-analysis to-date has investigated the relationship between nature connection and wellbeing in children and adolescents. This is the aim of the present study. We undertook searches through four databases (Google Scholar, ERIC, PsycInfo and Scopus). The criteria were (i) the mean age of participants is below 18, with no restrictions on sex or ethnicity and that they were drawn from the general population; (ii) that there were at least one explicit, non-dichotomised measure for nature connection and one for wellbeing and (iii) that there were adequate data reported so that we could record or compute the correlation coefficient between the main variables. Our systematic review identified twelve studies (k = 12) that fulfilled the criteria and could be included in the meta-analysis. The total sample (n = 30,075) included children and adolescents aged four to 18. An overall moderate significant effect was found (r = .31, 95% CI = .22-.41) for the relationship between nature connection and wellbeing in children and adolescents, which is comparable but slightly higher than the effect found in previous meta-analyses focused on adults.inpressinpres

Evaluating Quality of Life and Functional Outcomes in Salvage Surgery for Head and Neck Cancer

Background: Unique challenges surround treatment for residual or recurrent head and neck squamous cell carcinoma (HNSCC). Of the limited treatment options for residual or recurrent HNSCC, salvage surgery is often the best option. However, salvage surgery can result in significant morbidity, affecting both quality of life (QoL) and functional outcomes. Few studies have examined QoL outcomes following salvage surgery in the setting of HNSCC. Objectives: To analyze head and neck related quality of life and functional outcomes in patients with head and neck cancer who underwent salvage surgery. Methods: In this IRB approved study, FACT-HN Version 4 was administered pre-operatively and 6 months post-operatively to patients undergoing salvage surgery for HNSCC between November 4, 2014 and April 27, 2020. Retrospective cohort analysis was performed on this population with major outcome being postoperative QoL score. Functional outcomes included postoperative tracheostomy and feeding tube status. QoL outcomes were compared with paired t-tests. Univariate logistic regression was used to determine characteristics associated with presence of permanent tracheostomy and feeding tube, defined as presence greater than 30 days. Results: Overall, 25 patients undergoing salvage surgery for HNSCC were included in this analysis. Primary tumor sites were larynx/hypopharynx (44.0%), oral cavity (24.0%), oropharynx (20.0%), salivary (4.0%), skin (4.0%), and unknown primary (4.0%). Salvage surgeries consisted of total laryngectomy (36.0%), definitive neck dissection (24.0%), mandibulectomy (16.0%), parotidectomy (8.0%), with total laryngectomy/total glossectomy, radical tonsillectomy, TORS base of tongue excision, and transoral laser laryngeal excision all comprising 4% of cases. Total QoL scores were not significantly different preoperatively to postoperatively (mean 108.7, 95% CI=97.7 to 119.7 vs. 103.8, 95% CI: 93.1 to 114.5; P=0.436, with maximum total score of 148). Patients with lower preoperative Emotional Well-Being (EWB) subscores demonstrated significantly worse EWB subscores postoperatively (postoperative mean: 17.0, 95% CI: 14.5 to 19.4 vs. 21.7, 95% CI: 20.0 to 23.4; P=0.002). Of patients who underwent tracheostomy tube placement, 53.8% (N=7/13) remained tracheostomy dependent long-term (\u3e30 d). Of patients who underwent feeding tube placement, 81.0% (N=17/21) remained feeding tube dependent long-term (\u3e30 d). Tracheostomy and feeding tubes remained in place with median durations of 3.02 months (range 0.16 to 20.55) and 10.13 months (range 0 to 24.89), respectively. All patients with T3/4 disease undergoing salvage surgery required long-term feeding tube (N=6). Conclusions: This study provides important information about quality of life and functional outcomes for patients undergoing salvage surgery for HNSCC. There is a high rate of long-term tracheostomy and feeding tube dependence following salvage surgery. While no difference was found in head and neck related quality of life total score and sub-scores at 6 months postoperatively, general emotional well-being preoperatively was most associated with general emotional well-being postoperatively. This information should be taken into consideration when counseling and managing patients with residual or recurrent HNSCC