Use of Emoji in Pain Level Assessment in Pediatric Dental Patients

USE OF EMOJI IN PAIN LEVEL ASSESSMENT IN PEDIATRIC DENTAL PATIENTS Purpose: The purpose of this study is to determine the efficacy of a pain scale with Emoji images in comparison to the commonly used Wong-Baker FACES® pain scale. Methods: Healthy, English-speaking patients aged 4-17 presenting to the VCU Pediatric Dental clinic and the operating room and presenting to the MCV Pediatric Emergency Room were asked to rate their pain using the Wong-Baker FACES® and Emoji scales. These patients were then asked to select which pain scale they preferred. Results: A total of 151 children were enrolled in the study. The proposed Emoji scale was preferred by 86% of enrolled children (n=151). Children rated their pain the same on the two scales 78% of the time indicating a weak overall agreement between the two scales as defined by Cohen’s Kappa (k=0.5863, 95% CI: 0.47-0.70). In the instances of disagreement, 82% were within one image on the pain scale. There was a roughly even split between which scale corresponded to the higher pain level (56% Wong-Baker was higher and 44% Emoji was rated higher). Conclusions: A majority of the patients surveyed presented with no pain. The Emoji scale showed moderate agreement with the Wong-Baker FACES scale. A majority of the patients preferred the Emoji scale demonstrating the strong communicative utility of Emoji

A Self-Occulting Accretion Disk in the SW Sex Star DW UMa

We present the ultraviolet spectrum of the SW Sex star and nova-like variable DW UMa in an optical low state, as observed with the Space Telescope Imaging Spectrograph on board the Hubble Space Telescope (HST). The data are well described by a synthetic white dwarf (WD) spectrum with T_eff = 46,000 +/- 1000 K, log g = 7.60 +/- 0.15, v*sin(i) = 370 +/- 100 km/s and Z/Z_solar = 0.47 +/- 0.15. For this combination of T_eff and log g, WD models predict M_WD = 0.48 +/- 0.06 M_solar and R_WD = (1.27 +/- 0.18) * 10^9 cm. Combining the radius estimate with the normalization of the spectral fit, we obtain a distance estimate of d = 830 +/-150 pc. During our observations, DW UMa was approximately 3 magnitudes fainter in V than in the high state. A comparison of our low-state HST spectrum to a high-state spectrum obtained with the International Ultraviolet Explorer shows that the former is much bluer and has a higher continuum level shortward of 1450 A. Since DW UMa is an eclipsing system, this suggests that an optically thick accretion disk rim blocks our view of the WD primary in the high state. If self-occulting accretion disks are common among the SW Sex stars, we can account for (i) the preference for high-inclination systems within the class and (ii) their V-shaped continuum eclipses. Moreover, even though the emission lines produced by a self-obscured disk are generally still double-peaked, they are weaker and narrower than those produced by an unobscured disk. This may allow a secondary line emission mechanism to dominate and produce the single-peaked, optical lines that are a distinguishing characteristic of the SW Sex stars.Comment: 9 pages, including 2 figures; accepted for publication in Astrophysical Journal Letters; New version matches version in press (footnote added to discussion section; figures now use color

Optimization of CMOS at Deep Cryogenic Temperatures

Cryogenic CMOS is a sought-out technology because of its applications to fields like quantum computing and deep space exploration. Though slight advancements have been made within the field of cryogenic CMOS technology, there persists critical challenges that need to resolve to further advance the field. Hence, there is a need to solve challenges like understanding the undesirable effects due to the device physics at cryogenic temperatures such as high threshold voltage, kink-effects, abnormal subthreshold swing etc. and developing reliable circuit models because many rely on analytical modeling. The research models a NMOS ON-current and subthreshold slope at temperatures of 300K and 4K using Technology Computer-Aided Design (TCAD) by applying a single set of calibrated parameters. Additionally, detailing a proposed trap distribution model to reproduce abnormal subthreshold slope observed from 4K to 300K. The research also achieves to introduce an electron and hole mobility model for a wide temperature range since there has not been a unified model developed for silicon carriers from 4K to 300K. Lastly, the research aims to optimize MOSFETs at deep cryogenic temperatures by applying the calibrated parameters

Cardiovascular risk in first degree relatives of patients with premature coronary heart disease

Context: In most parts of the United Kingdom current cardiac services neglect assessment and primary prevention of cardiovascular disease in first degree relatives of patients with proven premature coronary heart disease. First degree relatives are at a higher risk than the general population by virtue of shared lifestyle risk and genetic factors to index cases. Objectives: This study aimed to identify first degree relatives of patients with proven coronary heart disease and assess their cardiovascular risk, using various cardiovascular risk assessment tools. We also aimed to assess the effectiveness of cardiovascular risk reduction services on the cardiovascular risk of the individual. Design, Setting, and Participation: A qualitative study was conducted at Sandwell Hospital. 43 participants aged 18- 74years were recruited. Results: The mean age of the cohort was 42(±4). 66% were under the age of 40years. At the baseline appointment 30% of the cohort, had a systolic blood pressure greater than 140mmHg, mean 140(±14.8) mmHg and 28% had a diastolic blood pressure greater than 90mmHg, mean 94(±2.12) mmHg. 82% of south Asians had a BMI greater than 23 Kg/m2. 63% of non south Asians had a BMI greater than <25 Kg/m2. 37%. 61% of the cohort’s total cholesterol was greater than 5mmol/l, mean 7.1(±1.8) mmol/l. 64% had triglycerides greater than 2.0mmol/l, mean 2.75(±0.49) mmol/l. The high density lipoprotein for males, 11% had a level greater than less than 1.0mmol/l, mean 1.2(±0.2) mmol/l, 4% of females had a level less than 1.2mmol/l, mean 1.4(±1) mmol/l. The cardiovascular tools QRISK, ETHRISK CVD, Framingham CVD identified over 10% of the cohort as high risk at the baseline appointment, and at the review appointment there was no change using QRISK. However, ETHRISK CVD and Framingham CVD demonstrated a risk reduction in the cohort. The tools varied in their selection of high risk, moderate risk and low risk. ETHRISK CHD and Framingham CHD and BNF identified 7% as high risk. Referral to specialist services was initiated with 14% referred for investigations, 21% commenced on medication or was altered. 12% of smokers were referred to a smoking cessation services. 25% referred to weight management service. 32% were referred to Cardiologist or Lipidologist. 19% referred to exercise on prescription. Conclusions: The study identified risk factors in individuals who would not conventionally access the current National Health Service Health Checks programme and should therefore be seen as complementary to NHS Health Checks. 66% were under the age of 40years who accessed the service. This population would not be able to access the systematic Health Checks programme provided by the National Health Service. This study therefore, illustrates the benefits of providing a tailored service for young individual’s potentially high risk and susceptible to premature CVD. This service enabled first degree relatives to choose a healthier lifestyle to reduce their risk of cardiovascular event in the future

Intubation: Difficult Airway

This chapter focuses on the difficult airway algorithm during the intubation process. The current published recommendations will address the definition of the difficult airway, steps by which to secure the airway, and when to employ a surgical airway in the form of tracheotomy or cricothyrodotomy. Finally, the role of the Otolaryngologist-Head and Neck Surgeon will be highlighted in the difficult airway team which should be multidisciplinary when handling airway concerns in a hospital. Overall, the goals of this chapter are to educate the reader on how to critically analyze and decide on the means to adopt a difficult airway algorithm in their own institution(s)

Robotic Simulation of Disc Arthroplasty Surgery: Influence of Surgical Placement on Motion Segment Dynamics

A variety of total disc replacement (TDR) designs exist for the treatment of disc pathologies. A key design parameter for a constrained ball and socket device is the location of the fixed center of rotation (COR). A previous study demonstrated that intact motion segment unit (MSU) mechanics and range of motion (ROM) were sensitive to the location of a prescribed sagittal plane rotational axis. Mal-alignment between the implant COR and the COR of the MSU may lead to an overloaded or over constrained condition. Two paradigms exist for the placement of a fixed COR TDR device relative to MSU anatomy: positioning the implant midline or posterior to midline. Presently, there are no data to indicate which paradigm may lead to better biomechanical/clinical outcome. This research attempts to evaluate changes in MSU mechanics and ROM as a result of variations in the size and placement of a simulated ball and socket TDR, like the ProDisc-L lumbar disc prosthesis. Six human cadaveric lumbar MSUs, L4-L5, were tested in flexion/extension using the Spine Robot to an end load limit of 8Nm. A fixed axis protocol was used to impose a pure rotation about a desired anatomical location. The Spine Robot was programmed to rotate the MSU about the COR of the implant. Subsequently, with the MSU held rigid, the implant was removed and rotation about the implant’s COR was repeated. Thereafter, simulated CORs were tested in different anatomical locations as defined by a customized grid pattern. The grid pattern consisted of 8 CORs which simulated the placement of a medium and large size constrained ball and socket device. Measurements of shear forces along the disc plane, axial force normal to the disc plane, segmental bending moment, and segmental ROM were analyzed at each grid point. Analysis of MSU mechanics and ROM for the ProDisc-L and Simulated Implant cases revealed that the two conditions were not comparable. Transfer of tissue pretension from the implant to the Spine Robot on removal of the implant, and dynamic contact forces at the implant surfaces were the contributing factors to the differences observed. Simulated COR testing demonstrated that the posterior tissue response was sensitive to varying placements of the simulated implant. For both implant sizes, posterior positioning of the COR required distraction of the disc space. During flexion, posterior positioning resulted in significantly higher shear and axial forces as well as a trend for reduced ROM. ROM in flexion may have been influenced by different starting positions within the neutral zone due to disc space distraction. During extension, the posterior placement of the COR reduced loading and increased rotation suggesting better alignment with, or separation of the facet joints. This novel study was able to delineate significant differences in spinal tissue response to varying simulated sizes and placements of an ideal fixed COR TDR device. The results of this study suggested that with both implant sizes the posterior placement of the COR will tend to distract the disc space and provide significantly increased ROM in extension at the expense of increased loads on posterior ligaments in flexion