Search

Competing Interests: JPS consults for Abbott, Biotronik, Boston Scientific, Cardiologs, Carelog, CVRx, DocGo, EBR, Impulse Dynamics, Implicity, I-Rhythm, Medtronic, Medscape, Microport, Notal Vision, Orchestra BioMed, Oura, Phillips, Sanofi, Smart Cardia, and Vektor Medical. ABL consults for Abbott. VP declares no competing interests.

Background: Mitral valve repair is commonly used to address degenerative or functional changes to the mitral valve apparatus and surrounding ventricular anatomy. Preoperative transoesophageal echocardiogram (TOE) is routinely used to evaluate and identify the precise anatomic location of mitral valve pathology in order to guide repair. However, surgeons currently lack specific guidance regarding the approximate dimensions of the mitral valve they should aim for in order to achieve optimal valve function and avoid adverse outcomes. Therefore, through an observational study, we aimed to develop and test the accuracy of a preliminary mathematical model which represents the geometric relationship between various clinically relevant components of the mitral valve and its surrounding structures., Methods: Using established trigonometric principles, the geometric relationship shared between several mitral valve components was represented in a two-dimensional (2D) model and described in a mathematical equation. The output variable of the model is the anteroposterior diameter of the mitral valve. To assess the accuracy of the mathematical model, we compared the model-predicted anteroposterior (AP) diameter against AP diameter measured by postoperative TOE in 42 cases., Results: The root mean squared error (RMSE) of model predicted AP diameter compared to measured AP diameter was 0.43 cm. The mean absolute percentage error (MAPE) of the model was 17.7%. In 34 out of 42 cases, model-predicted AP diameters were within 25% of AP diameters measured by postoperative TOE., Conclusions: Preliminary testing of a simple mathematical model has shown its relative accuracy in representing the geometric relationship between several mitral valve variables. Further research and refinement of the model is required in order to improve its accuracy. We are encouraged that, with further improvement, the model has the potential for clinical application., (Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Objective: To model cost and benefit of a national community health worker workforce., Design: Modelling exercise based on all general practices in England., Setting: United Kingdom National Health Service Primary Care., Participants: Not applicable., Data Sources: Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake., Main Outcome Measures: We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients., Results: Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease., Conclusion: A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

Background: In the United Kingdom (UK), a number of National Health Service (NHS) Clinical Commissioning Groups (CCG) have proposed controversial measures to restrict elective surgery for patients who either smoke or are obese. Whilst the nature of these measures varies between NHS authorities, typically, patients above a certain Body Mass Index (BMI) and smokers are required to lose weight and quit smoking prior to being considered eligible for elective surgery. Patients will be supported and monitored throughout this mandatory period to ensure their clinical needs are appropriately met. Controversy regarding such measures has primarily centred on the perceived unfairness of targeting certain health states and lifestyle choices to save public money. Concerns have also been raised in response to rhetoric from certain NHS authorities, which may be taken to imply that such measures punitively hold people responsible for behaviours affecting their health states, or simply for being in a particular health state., Main Body: In this paper, we examine the various elective surgery rationing measures presented by NHS authorities. We argue that, where obesity and smoking have significant implications for elective surgical outcomes, bearing on effectiveness, the rationing of this surgery can be justified on prognostic grounds. It is permissible to aim to maximise the benefit provided by limited resources, especially for interventions that are not urgently required. However, we identify gaps in the empirical evidence needed to conclusively demonstrate these prognostic grounds, particularly for obese patients. Furthermore, we argue that appeals to personal responsibility, both in the prospective and retrospective sense, are insufficient in justifying this particular policy., Conclusion: Given the strength of an alternative justification grounded in clinical effectiveness, rhetoric from NHS authorities should avoid explicit statements, which suggest that personal responsibility is the key justificatory basis of proposed rationing measures.

This paper reports the condensation and subsequent motion of water droplets on bi-philic surfaces, surfaces that are patterned with regions of different wettability. Bi-philic surfaces can enhance the water collection efficiency: droplets condensing on hydrophobic regions wick into hydrophilic drain channels when droplets grow to a certain size, renewing the condensation on the dry hydrophobic region. The onset of drain phenomenon can be triggered by multiple events with distinct nature ranging from gravity, direct contact between a droplet and a drain channel, to a mutual coalescence between droplets. This paper focuses on the effect of the length scale of hydrophobic regions on the dynamics of mutual coalescence between droplets and subsequent drainage. The main hypothesis was that, when the drop size is sufficient, the kinetic energy associated with a coalescence of droplets may cause dynamic advancing of a newly formed drop, leading to further coalescence with nearby droplets and ultimately to a chain reaction. We fabricate bi-philic surfaces with hydrophilic and hydrophobic stripes, and the result confirms that coalescing droplets, when the length scale of droplets increases beyond 0.2mm, indeed display dynamic expansion and chain reaction. Multiple droplets can thus migrate to hydrophilic drain simultaneously even when the initial motion of the droplets was not triggered by the direct contact between the droplet and the hydrophilic drain. Efficiency of drain due to mutual coalescence of droplets varies depending on the length scale of bi-philic patterns, and the drain phenomenon reaches its peak when the width of hydrophobic stripes is between 800μm and 1mm. The Ohnesorge number of droplets draining on noted surfaces is between 0.0042 and 0.0037 respectively. The observed length scale of bi-philic patterns matches that on the Stenocara beetle's fog harvesting back surface. This match between length scales suggests that the surface of the insect is optimized for the drain of harvested water., (Copyright © 2017 Elsevier Inc. All rights reserved.)