Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members

Objective: Hypothyroid patients frequently request specific therapies from their physicians. Combination therapy is vigorously discussed at professional meetings. We wished to determine if physician prescribing patterns for hypothyroidism changed during 2017 after specific educational events.Methods: A survey addressing treatment of hypothyroidism was emailed to American Thyroid Association (ATA) members on three occasions in 2017. The Spring emails were sent prior to a satellite symposium addressing hypothyroidism, and prior to the annual Endocrine Society and ATA meetings; the December emails were sent after these events. Physicians were presented with thirteen theoretical patients and chose from 6 therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and liothyronine monotherapy. The patient scenarios successively incorporated factors potentially providing reasons for considering combination therapy. Multivariate repeated measures logistic regression analyses first examined effects of physician characteristics on prescribing the various therapies. Then, analyses also incorporated timing, by comparing prescribing patterns in February, March, and December.Results: In analyses of prescribing levothyroxine monotherapy vs. any T3 therapy, there was a trend of borderline significance (p = 0.053) for T3 therapy to be prescribed more in December compared with February-March combined. When multivariate analyses were performed controlling for time and physician characteristics, choice of therapy was only significantly affected by country of practice (OR 1.7, CI 1.3–2.2). Physician choice of therapies was also examined for the options of continuing (1) levothyroxine, vs. (2) increasing levothyroxine, (3) adding liothyronine either with or without levothyroxine reduction, or (4) replacing levothyroxine with desiccated thyroid extract or liothyronine. When multivariate analyses incorporating time and physician characteristics were performed, respondents in December (OR 1.5, CI 1.0–2.3) and those practicing in North America (OR 1.8, CI 1.2–2.6) were more likely to prescribe liothyronine.Conclusions: This survey shows that although current North American guidelines do not recommend combination therapy, such therapy is being prescribed more over time and is also more commonly prescribed in North America. It is possible our guidelines are failing to incorporate evidence that physicians are considering when prescribing combination therapy. Such evidence could include data about patient preferences, and this needs to be a focus of future studies

Dental Emergencies in the Current Health Care System

A huge problem in the current health system is that Oral care is not currently integrated into the overall health system, given the lack of dental coverage for underserved adults, and the insufficient amount of dentists available for individuals with dental coverage. The lack of education regarding the importance of oral health and shortage in the number of dentists and dental coverage leads to an influx of patients with mild to severe dental problems at the emergency departments (EDs) across the country. Many studies conclude that by integrating oral health into the overall health system, there would an increase in availability for oral care that would be beneficial to patients, and it would be easier and more affordable for the ED to deal with an influx of patients with oral problems. This study examines reasons why patients with dental problems visit the ED at any of MedStar’s hospitals. The study will allow us to improve our current understanding of dental emergencies treated at EDs. The study uses MedStar’s database to identify individuals who visited the ED for oral issues or emergencies. We will examine correlations between the dental emergency type and certain demographics as well as insurance type

Splitting steam via eutectic molten hydroxide assisted electrolysis for hydrogen gas production

In recent years, the development of hydrogen gas production from renewable energy sources has become a major area of focus to cover the shortfalls in demands of global energy. The development of water electrolysis can be considered as a promising technique in this regard for increasing the production of hydrogen fuel to meet energy requirements. In this research, the splitting steam via eutectic molten hydroxide (NaOH-KOH; 49-51 mol%) electrolysis for hydrogen gas production has been electrochemically investigated. A new reference electrode for eutectic molten hydroxide has been fabricated by covering Ni/Ni(OH)2 with an ionic membrane of alumina or mullite tube. It was found that the Ni/Ni(OH)2 covered with a mullite membrane was stable and reusable over a range of temperatures (225-300oC) without any deterioration. The Ni/Ni(OH)2 covered by a mullite tube reference electrode has been compared with silver and platinum quasi−reference electrodes. The results have shown the designed reference electrode had a more stable and effective performance towards controlling the platinum working electrode as compared to the other quasi-reference electrodes. In addition, this work carried out a cyclic voltammetry investigation of different working electrodes such as Ni, Pt, Ag, Mo, and stainless steel (SS) using eutectic molten hydroxide at different operating temperatures to examine the occurring reaction on each electrode. The comparison of cyclic voltammetry for examined working electrodes found that the reduction potential for hydrogen evolution was in order of (more positive potential to negative): Ni>Pt>Ag>SS>Ag>Mo. This finding has been additionally confirmed by chronoamperometry. Finally, the high-temperature eutectic molten hydroxide domain has been electrochemically investigated to split steam into hydrogen fuel. The electrolysis investigations were carried out using nickel, platinum, and stainless steel as the cathode while for the anode, stainless steel and graphite was used. Electrolysis was explored at a temperature range between 225 to 300oC and at different applied voltages of 1.5 to 2.5 V. The current efficiency achieved using stainless steel as an anode and using nickel, stainless steel and platinum as a cathode at 300oC were 90.5%, 80.0% and 68.6% respectively. The current efficiency using graphite anode for an individual cathode material was lower than that for stainless steel anode. Consequently, splitting steam via molten hydroxides for hydrogen was shown a promising alternative to current technology for hydrogen production, with beneficial implications to integrate with renewable energy sources to generate the process

Electrochemical investigation of novel reference electrode Ni/Ni(OH)₂ in comparison with silver and platinum inert quasi-reference electrodes for electrolysis in eutectic molten hydroxide

An efficient and green energy carrier hydrogen (H2) generation via water splitting reaction has become a major area of focus to meet the demand of clean and sustainable energy sources. In this research, the splitting steam via eutectic molten hydroxide (NaOH–KOH; 49–51 mol%) electrolysis for hydrogen gas production has been electrochemically investigated at 250–300 °C. Three types of reference electrodes such as a high-temperature mullite membrane Ni/Ni(OH)2, quasi-silver and quasi-platinum types were used. The primary purpose of this electrode investigation was to find a suitable, stable, reproducible and reusable reference electrode in a molten hydroxide electrolyte. Cyclic voltammetry was performed to examine the effect on reaction kinetics and stability to control the working electrode at different scan rate and molten salt temperature. The effect of introducing water to the eutectic molten hydroxide via the Ar gas stream was also investigated. When the potential scan rate was changed from 50 to 150 mV s−1, the reduction current for the platinum wire working electrode was not changed with newly prepared nickel reference electrode that designates its stability and reproducibility. Furthermore, increasing the operating temperature of molten hydroxides from 250 to 300 °C the reduction potential of the prepared nickel reference electrode is slightly positive shifted about 0.02 V. This suggests that it has good stability with temperature variations. The prepared nickel and Pt reference electrode exhibited stable and reliable cyclic voltammetry results with and without the presence of steam in the eutectic molten hydroxide while Ag reference electrode exposed positive shifts of up to 0.1 V in the reduction potential. The designed reference electrode had a more stable and effective performance towards controlling the platinum working electrode as compared to the other quasi-reference electrodes. Consequently, splitting steam via molten hydroxides for hydrogen has shown a promising alternative to current technology for hydrogen production that can be used for thermal and electricity generation

Electrochemical study of different membrane materials for the fabrication of stable, reproducible and reusable reference electrode

© 2020 Fabrication of stable, reproducible and reusable reference electrodes for low energy and high-temperature steam splitting is of great interest for hydrogen fuel production without anthropogenic carbon dioxide (CO2) emission. This study has been conducted for the detection of suitable material for the fabrication of novel reference electrode. In the present scenario, this research is designed to fabricate a novel nickel reference electrode by using operating conditions of eutectic molten hydroxide (NaOH-KOH, 49–51 mol%) at temperature 300 °C in an ion-conducting membrane of alumina and mullite tube. Afterwards, the designed nickel reference electrode has been examined for its reusability and stability by using electrochemical technique and cyclic voltammetry. Five scans of cyclic voltammetry are performed for both membrane fabricated reference electrode. A slight positive shift in oxidation peaks is observed for mullite membrane electrode (64 mV from scan 1 to 5). The stability measurements are noted by changing the scan rate between 50 and 150 mV s−1. Furthermore, the results show that the Ni/Ni(OH)2 reference electrode covered with a mullite membrane is stable and reusable at 300 °C temperature without any deterioration. The stability and reusability of prepared nickel reference electrode covered by mullite tube in the eutectic molten hydroxide were up to 9 days to carry out an electrochemical investigation, while for alumina tube reference electrode the stability and reliability were up to 3 days. The internal electrolytic material and ionic conductance can play an important role for future studies with this reference electrode along with optimisation of temperature and scan rate parameters

Enhancing hydrogen production from steam electrolysis in molten hydroxides via selection of non-precious metal electrodes

© 2020 Hydrogen Energy Publications LLC There are still gaps in the field of reference electrode that is needed to assist electrolysis in high temperature electrolytes (e.g. molten hydroxides) for H2 gas production. This research aims to fill the gaps by preparing Ni/Ni(OH)2 reference electrode and more importantly testing its effectiveness against important performance factors including; ion conducting membrane (e.g. mullite tubes), internal electrolyte composition, working temperature and electrochemical control (e.g. potential scan rate). Then, this reference electrode was used to study the electrocatalytic activity various cheaper working electrode materials including; stainless steel (St.st), Ni, Mo and Ag in comparison with Pt by the means of chronoamperometry and voltammetry. The effect of introducing steam into electrolyte (eutectic mixture of NaOH and KOH) on the electrocatalytic activity of these working electrodes was also studied. It was observed that the potential of hydrogen evolution with different working electrodes followed an order as; Pt > Ni > St. st > Ag > Mo (positive to negative). The performance of each working electrode was confirmed through chronoamperometry for hydrogen evolution at a constant potential of −0.7 V. It was also found in cyclic voltammetry and confirmed by chronoamperometry that the introduction of steam was apparent as increasing the current density at cathodic limit for hydrogen evolution. This study could help to develop non-precious metal electrodes for the production of hydrogen fuel. In future, there will be a potential in the threshold concentration of steam for H2 gas production

Talk2Care: Facilitating Asynchronous Patient-Provider Communication with Large-Language-Model

Despite the plethora of telehealth applications to assist home-based older adults and healthcare providers, basic messaging and phone calls are still the most common communication methods, which suffer from limited availability, information loss, and process inefficiencies. One promising solution to facilitate patient-provider communication is to leverage large language models (LLMs) with their powerful natural conversation and summarization capability. However, there is a limited understanding of LLMs' role during the communication. We first conducted two interview studies with both older adults (N=10) and healthcare providers (N=9) to understand their needs and opportunities for LLMs in patient-provider asynchronous communication. Based on the insights, we built an LLM-powered communication system, Talk2Care, and designed interactive components for both groups: (1) For older adults, we leveraged the convenience and accessibility of voice assistants (VAs) and built an LLM-powered VA interface for effective information collection. (2) For health providers, we built an LLM-based dashboard to summarize and present important health information based on older adults' conversations with the VA. We further conducted two user studies with older adults and providers to evaluate the usability of the system. The results showed that Talk2Care could facilitate the communication process, enrich the health information collected from older adults, and considerably save providers' efforts and time. We envision our work as an initial exploration of LLMs' capability in the intersection of healthcare and interpersonal communication.Comment: Under submission to CHI202

Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers

IntroductionEfforts to achieve opioid guideline concordant care may be undermined when patients access multiple opioid prescription sources. Limited data are available on the impact of dual-system sources of care on receipt of opioid medications.ObjectiveWe examined whether dual-system use was associated with increased rates of new opioid prescriptions, continued opioid prescriptions and diagnoses of opioid use disorder (OUD). We hypothesized that dual-system use would be associated with increased odds for each outcome.MethodsThis retrospective cohort study was conducted using Veterans Administration (VA) data from two facilities from 2015 to 2019, and included active patients, defined as Veterans who had at least one encounter in a calendar year (2015–2019). Dual-system use was defined as receipt of VA care as well as VA payment for community care (non-VA) services. Mono users were defined as those who only received VA services. There were 77,225 dual-system users, and 442,824 mono users. Outcomes were three binary measures: new opioid prescription, continued opioid prescription (i.e., received an additional opioid prescription), and OUD diagnosis (during the calendar year). We conducted a multivariate logistic regression accounting for the repeated observations on patient and intra-class correlations within patients.ResultsDual-system users were significantly younger than mono users, more likely to be women, and less likely to report white race. In adjusted models, dual-system users were significantly more likely to receive a new opioid prescription during the observation period [Odds ratio (OR) = 1.85, 95% confidence interval (CI) 1.76–1.93], continue prescriptions (OR = 1.24, CI 1.22–1.27), and to receive an OUD diagnosis (OR = 1.20, CI 1.14–1.27).DiscussionThe prevalence of opioid prescriptions has been declining in the US healthcare systems including VA, yet the prevalence of OUD has not been declining at the same rate. One potential problem is that detailed notes from non-VA visits are not immediately available to VA clinicians, and information about VA care is not readily available to non-VA sources. One implication of our findings is that better health system coordination is needed. Even though care was paid for by the VA and presumably closely monitored, dual-system users were more likely to have new and continued opioid prescriptions

SUPREME-HN: a retrospective biomarker study assessing the prognostic value of PD-L1 expression in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck.

BACKGROUND:Programmed cell death ligand-1 (PD-L1) expression on tumor cells (TCs) is associated with improved survival in patients with head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy, although its role as a prognostic factor is controversial. This study investigates whether tumoral expression of PD-L1 is a prognostic marker in patients with recurrent and/or metastatic (R/M) HNSCC treated with standard chemotherapy. METHODS:This retrospective, multicenter, noninterventional study assessed PD-L1 expression on archival R/M HNSCC tissue samples using the VENTANA PD-L1 (SP263) Assay. PD-L1 high was defined as PD-L1 staining of ≥ 25% TC, with exploratory scoring at TC ≥ 10% and TC ≥ 50%. The primary objective of this study was to estimate the prognostic value of PD-L1 status in terms of overall survival (OS) in patients with R/M HNSCC. RESULTS:412 patients (median age, 62.0 years; 79.9% male; 88.2% Caucasian) were included from 19 sites in seven countries. 132 patients (32.0%) had TC ≥ 25% PD-L1 expression; 199 patients (48.3%) and 85 patients (20.6%) had TC ≥ 10% and ≥ 50%, respectively. OS did not differ significantly across PD-L1 expression (at TC ≥ 25% cutoff median OS: 8.2 months vs TC < 25%, 10.1 months, P = 0.55) or the ≥ 10% and ≥ 50% cutoffs (at TC ≥ 10%, median OS: 9.6 months vs TC < 10%, 9.4 months, P = 0.32, and at TC ≥ 50%, median OS 7.9 vs TC < 50%, 10.0 months, P = 0.39, respectively). CONCLUSIONS:PD-L1 expression, assessed using the VENTANA PD-L1 (SP263) Assay, was not prognostic of OS in patients with R/M HNSCC treated with standard of care chemotherapies. Trial registration ClinicalTrials.gov, NCT02543476. Registered September 4, 2015