Particle-assisted formation of oil-in-liquid metal emulsions.

Gallium-based liquid metals (LMs) have surface tension an order of magnitude higher than water and break up into micro-droplets when mixed with other liquids. In contrast, silicone oil readily mixes into LM foams to create oil-in-LM emulsions with oil inclusions. Previously, the LM was foamed through rapid mixing in air for an extended duration (over 2 h). This process first results in the internalization of oxide flakes that form at the air-liquid interface. Once a critical fraction of these randomly shaped solid flakes is reached, air bubbles internalize into the LM to create foams that can internalize secondary liquids. Here, we introduce an alternative oil-in-LM emulsion fabrication method that relies on the prior addition of SiO2micro-particles into the LM before mixing it with the silicone oil. This particle-assisted emulsion formation process provides a higher control over the composition of the LM-particle mixture before oil addition, which we employ to systematically study the impact of particle characteristics and content on the emulsions' composition and properties. We demonstrate that the solid particle size (0.8µm to 5µm) and volume fraction (1%-10%) have a negligible impact on the internalization of the oil inclusions. The inclusions are mostly spherical with diameters of 20-100µm diameter and are internalized by forming new, rather than filling old, geometrical features. We also study the impact of the particle characteristics on the two key properties related to the functional application of the LM emulsions in the thermal management of microelectronics. In particular, we measure the impact of particles and silicone oil on the emulsion's thermal conductivity and its ability to prevent deleterious gallium-induced corrosion and embrittlement of contacting metal substrates.

Computational design of MmpL3 inhibitors for tuberculosis therapy.

Tuberculosis is a chronic communicable disease caused by Mycobacterium tuberculosis (Mtb) and spreads from lungs to lymphatic system. The cell wall of mycobacterium plays a prominent role in maintaining the virulence and pathogenicity and also acts as prime target for drug discovery. Hence, this study has put into emphasis with target MmpLs (Mycobacterial membrane proteins Large) which are significant for the growth and survival of Mycobacterium tuberculosis. MmpLs belongs to the resistance, nodulation and division (RND) protein superfamily. MmpL3 is the only MmpL deemed essential for the replication and viability of mycobacterial cells. For the study, we have selected SQ109 derivatives as Mmpl3 inhibitor, which holds non-covalent property. Structure-based pharmacophore model of MmpL3 target protein with SQ109 as co-crystallized ligand (PDB: 6AJG) was generated to screen the ligand database. Compounds with decent fitness score and pharmacophoric features were compared with standard drug and taken for molecular docking studies. Further prime molecular mechanics-Poisson-Boltzmann surface area (MM-GBSA) and induced fit calculations identified potential molecules for further drug-likeness screening. Overall computational calculations identified ZINC000000016638 and ZINC000000003594 as potential in silico MmpL3 inhibitors. Molecular dynamics simulations integrated with MM-PBSA free energy calculations identified that MmpL3-ZINC000000016638 complex was more stable. Study can be further extended for synthesis and biological evaluation, derivatization of active compound to identify potential and safe lead compounds for effective tuberculosis therapy.

Economic evaluations of audit and feedback interventions: a systematic review.

BACKGROUND: The effectiveness of audit and feedback (A&F) interventions to improve compliance to healthcare guidelines is supported by randomised controlled trials (RCTs) and meta-analyses of RCTs. However, there is currently a knowledge gap on their cost-effectiveness. OBJECTIVE: We aimed to assess whether A&F interventions targeting improvements in compliance to recommended care are economically favourable. METHODS: We conducted a systematic review including experimental, observational and simulation-based economic evaluation studies of A&F interventions targeting healthcare providers. Comparators were a 'do nothing' strategy, or any other intervention not involving A&F or involving a subset of A&F intervention components. We searched MEDLINE, CINAHL, CENTRAL, Econlit, EMBASE, Health Technology Assessment Database, MEDLINE, NHS Economic Evaluation Database, ABI/INFORM, Web of Science, ProQuest and websites of healthcare quality associations to December 2021. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental net benefit and incremental cost-benefit ratios. Pairs of reviewers independently selected eligible studies and extracted relevant data. Reporting quality was evaluated using CHEERS (Consolidated Health Economic Evaluation Reporting Standards). Results were synthesised using permutation matrices for all studies and predefined subgroups. RESULTS: Of 13 221 unique citations, 35 studies met our inclusion criteria. The A&F intervention was dominant (ie, at least as effective with lower cost) in 7 studies, potentially cost-effective in 26 and was dominated (ie, the same or less effectiveness and higher costs) in 2 studies. A&F interventions were more likely to be economically favourable in studies based on health outcomes rather than compliance to recommended practice, considering medical costs in addition to intervention costs, published since 2010, and with high reporting quality. DISCUSSION: Results suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value.

Reducing low-value testing in the emergency department through cost-effective physician education and personalised audit and feedback scorecards.

OBJECTIVES: Delivery of low-value healthcare impacts patients, resources, and overall healthcare sustainability. In Canada, an estimated 30% of tests, treatments, and procedures are unnecessary. As primary decision-makers, physicians have a major influence on healthcare utilisation. Despite numerous approaches to reduce low-value testing, success has been limited. Audit and feedback strategies have demonstrated variable effects in changing physician practice and often do not consider resource requirements. The objective of this study is to evaluate a resource-effective approach to decrease low-value testing in the emergency department (ED) through online education and personalised audit and feedback scorecards for two common ED tests. METHODS: A single-centre, prospective pre-post trial of 31 ED physician's ordering rates of urine cultures and rib X-rays was conducted at an academic community hospital in Ottawa, Ontario. The study included educational interventions on appropriate ordering guidelines and personalised audit and feedback scorecards from 2019 to 2020. RESULTS: There was a 36.9 and 81.6% relative reduction in urine culture and rib X-ray ordering, respectively, between the baseline intervention and the 12-month post-scorecard period (p < 0.01). The group dispersion in ordering rates during the post-scorecard period was smaller compared to the wide dispersion at baseline. The rate of return ED visits for both tests remained unchanged. Variable cost analysis demonstrated $53,300 in cost-savings from reduced testing rates during the study period. The total study cost was $15,000. INTERPRETATION: The combination of online education and personalised audit and feedback scorecards may present a resource-effective approach to change physician practice and reduce low-value testing in the ED. Further studies are needed to examine this approach in other departments and clinical topics in Canada.

RéSUMé: OBJECTIFS: La prestation de soins de santé de faible valeur a un impact sur les patients, les ressources et la durabilité globale des soins de santé. Au Canada, on estime que 30 % des tests, des traitements et des procédures sont inutiles. En tant que principaux décideurs, les médecins ont une influence majeure sur l'utilisation des soins de santé. Malgré de nombreuses approches visant à réduire les tests de faible valeur, le succès a été limité. Les stratégies de vérification et de rétroaction ont démontré des effets variables sur l'évolution de la pratique des médecins et ne tiennent souvent pas compte des besoins en ressources. L'objectif de cette étude est d'évaluer une approche efficace en termes de ressources pour réduire les tests de faible valeur dans le service des urgences grâce à une formation en ligne et à des fiches d'audit personnalisés et de rétroaction pour deux tests courants aux urgences. MéTHODES: Un essai prospectif avant-après dans un seul centre portant sur les taux de prescription de cultures d'urine et de radiographies des côtes par trente et un médecins du service d'urgence a été mené dans un hôpital communautaire universitaire à Ottawa, en Ontario. L'étude comprenait des interventions éducatives sur les directives de commande appropriées et des fiches d'audit et de retour d'information personnalisées de 2019 à 2020. RéSULTATS: Il y avait une réduction relative de 36,9 % et 81,6 % de la culture d'urine et de la commande de radiographies des côtes respectivement, entre l'intervention de base et la période de 12 mois après la fiche de notation (p < 0,01). La dispersion des groupes dans les taux de commande au cours de la période post-bilan était plus faible par rapport à la large dispersion au départ. Le taux de retour des visites aux urgences pour les deux tests est resté inchangé. L'analyse des coûts variables a montré que la réduction des taux de dépistage pendant la période d'étude a permis de réaliser des économies de 53 300 dollars. Le coût total de l'étude s'est élevé à 15 000 dollars. INTERPRéTATION: L'association d'une formation en ligne et de fiches d'audit et de retour d'information personnalisées peut constituer une approche efficace en termes de ressources pour modifier les pratiques des médecins et réduire les tests à faible valeur dans les urgences. D'autres études sont nécessaires pour examiner cette approche dans d'autres départements et sujets cliniques au Canada.

Evaluating physician awareness of common health care costs in the emergency department.

BACKGROUND: Health care costs are on the rise in Canada and the sustainability of our health care system is at risk. As gatekeepers to patient care, emergency department (ED) physicians have a direct impact on health care costs. We aimed to identify current levels of cost awareness among ED physicians. By understanding the current level of physician cost awareness, we hope to identify areas where cost education would provide the greatest benefit in reducing ordering costs. METHODS: We conducted a survey evaluating current awareness of common ordering costs among ED physicians from two tertiary teaching hospitals. Our study population was comprised of 124, certified emergency medicine staff physicians and emergency medicine resident physicians. Our survey asked ED physicians to estimate the costs of 41 items across four categories of day-to-day ordering: imaging investigations, materials, laboratory tests, and pharmaceuticals. Items were selected based on frequency of use, availability of cost-effective alternatives, and tests considered to be "low yield". The primary outcome was percentages of underestimates, correct estimates, and overestimates for ED costs among ED physicians. RESULTS: The average percentage of correct cost estimates among ED physicians was 14% across the four ordering categories. Where cost-effective alternatives exist, ED physicians overestimated the cost of the more cost-effective item. They also underestimated the cost of low-yield tests.InterpretationED physicians demonstrated limited cost awareness of common health care costs. Further studies that characterize utilization of hospital resources based on ED physician awareness of cost-effective alternatives and cost of "low yield" tests are needed.

Investigating the necessity of computed tomographic scans in children with headaches: a retrospective review.

OBJECTIVE: Headaches are a common problem in the pediatric population. In 2002, the American Academy of Neurology (AAN) developed guidelines on neuroimaging for patients presenting with headache. Our objective was to determine the frequency of computed tomographic (CT) scanning ordered by a range of medical practitioners for pediatric patients presenting with primary headache. METHODS: A retrospective chart review was conducted at the Children's Hospital of Eastern Ontario (CHEO), a tertiary care centre in Ontario. One hundred fifty-one records of patients referred to the outpatient neurology clinic at CHEO with ''headache'' or ''migraine'' as the primary complaint from 2004 to 2009 were randomly selected. Ninety-nine patients with normal neurologic examinations were ultimately included. RESULTS: Thirty-four patients (34%; 95% CI 25-45) had undergone CT scanning. None of the 34 CT scans (0%; 95% CI 0-10) showed significant findings, and none changed the headache diagnosis or management. Eleven (32%) of the CT scans were ordered by CHEO neurologists, 15 (44%) by community physicians, and 8 (24%) by CHEO emergency physicians. CONCLUSION: A high proportion of children presenting with primary headaches and a normal neurologic examination undergo CT scanning, despite well-established AAN guidelines regarding neuroimaging. Most of these CT scans do not appear to alter diagnosis and management. A variety of non-evidencebased factors may be encouraging physicians to overinvestigate this population and, as a result, increasing the risk of adverse events due to radiation exposure. Implementing initiatives at a site-based level that promote the use of established guidelines before performing CT scanning in this population may be beneficial.