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1.
Opt Lett ; 49(1): 73-76, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-38134157

RESUMEN

We report single-shot, time-resolved observation of self-steepening and temporal splitting of near-infrared, 50 fs, micro-joule pulses propagating nonlinearly in flint (SF11) glass. A coherent, smooth-profiled, 60-nm-bandwidth probe pulse that propagated obliquely to the main pulse through the Kerr medium recorded a time sequence of longitudinal projections of the main pulse's induced refractive index profile in the form of a phase-shift "streak," in which frequency-domain interferometry recovered with ∼10 fs temporal resolution. A three-dimensional simulation based on a unidirectional pulse propagation equation reproduced observed pulse profiles.

2.
Phys Rev Lett ; 127(10): 104801, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34533351

RESUMEN

Hollow plasma channels are attractive for lepton acceleration because they provide intrinsic emittance preservation regimes. However, beam breakup instabilities dominate the dynamics. Here, we show that thin, warm hollow channels can sustain large-amplitude plasma waves ready for high-quality positron acceleration. We verify that the combination of warm electrons and thin hollow channels enables positron focusing structures. Such focusing wakefields unlock beam breakup damping mechanisms. We demonstrate that such channels emerge self-consistently during the long-term plasma dynamics in the blowout's regime aftermath, allowing for experimental demonstration.

3.
Phys Rev Lett ; 125(1): 014801, 2020 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-32678646

RESUMEN

We report observations of coherent optical transition radiation interferometry (COTRI) patterns generated by microbunched ∼200-MeV electrons as they emerge from a laser-driven plasma accelerator. The divergence of the microbunched portion of electrons, deduced by comparison to a COTRI model, is ∼9× smaller than the ∼3 mrad ensemble beam divergence, while the radius of the microbunched beam, obtained from COTR images on the same shot, is <3 µm. The combined results show that the microbunched distribution has estimated transverse normalized emittance ∼0.4 mm mrad.

4.
J Microsc ; 276(3): 109-117, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31696508

RESUMEN

We combined optical and atomic force microscopy to observe morphology and kinetics of microstructures (typically referred to as bees) that formed at free surfaces of unmodified Performance Graded (PG) 64-22 asphalt binders upon cooling from 150°C to room temperature (RT) at 5°C min-1 , and changes in these microstructures when the surface was terminated with a transparent solid (glass) or liquid (glycerol) overlayer. The main findings are: (1) at free binder surfaces, wrinkled microstructures started to form near the crystallization temperature (∼45°C) of saturates such as wax observed by differential scanning calorimetry, then grew to ∼5 µm diameter, ∼25 nm wrinkle amplitude and 10-30% surface area coverage upon cooling to RT, where they persisted indefinitely without observable change in shape or density. (2) Glycerol coverage of the binder surface during cooling reduced wrinkled area and wrinkle amplitude three-fold compared to free binder surfaces upon initial cooling to RT; continued glycerol coverage at RT eliminated most surface microstructures within ∼4 h. (3) No surface microstructures were observed to form at binder surfaces covered with glass. (4) Submicron bulk microstructures were observed by near-infrared microscopy beneath the surfaces of all binder samples, with size, shape and density independent of surface coverage. No tendency of such structures to float to the top or sink to the bottom of mm-thick samples was observed. (5) We attribute the dependence of surface wrinkling on surface coverage to variation in interface tension, based on a thin-film continuum mechanics model. LAY DESCRIPTION: Asphalt binder, or bitumen, is the glue that holds aggregate particles together to form a road surface. It is derived from the heavy residue that remains after distilling gasoline, diesel and other lighter products out of crude oil. Nevertheless, bitumen varies widely in composition and mechanical properties. To avoid expensive road failures, bitumen must be processed after distillation so that its mechanical properties satisfy diverse climate and load requirements. International standards now guide these mechanical properties, but yield varying long-term performance as local source composition and preparation methods vary. In situ diagnostic methods that can predict bitumen performance independently of processing history are therefore needed. The present work focuses on one promising diagnostic candidate: microscopic observation of internal bitumen structure. Past bitumen microscopy has revealed microstructures of widely varying composition, size, shape and density. A challenge is distinguishing bulk microstructures, which directly influence a binder's mechanical properties, from surface microstructures, which often dominate optical microscopy because of bitumen's opacity and scanning-probe microscopy because of its inherent surface specificity. In previously published work, we used infrared microscopy to enhance visibility of bulk microstructure. Here, as a foil to this work, we use visible-wavelength microscopy together with atomic-force microscopy (AFM) specifically to isolate surface microstructure, to understand its distinct origin and morphology, and to demonstrate its unique sensitivity to surface alterations. To this end, optical microscopy complements AFM by enabling us to observe surface microstructures form at temperatures (50°C-70°C) at which bitumen's fluidity prevents AFM, and to observe surface microstructure beneath transparent, but chemically inert, liquid (glycerol) and solid (glass) overlayers, which alter surface tension compared to free surfaces. From this study, we learned, first, that, as bitumen cools, distinctly wrinkled surface microstructures form at the same temperature at which independent calorimetric studies showed crystallization in bitumen, causing it to release latent heat of crystallization. This shows that surface microstructures are likely precipitates of the crystallizable component(s). Second, a glycerol overlayer on the cooling bitumen results in smaller, less wrinkled, sparser microstructures, whereas a glass overlayer suppresses them altogether. In contrast, underlying smaller bulk microstructures are unaffected. This shows that surface tension is the driving force behind formation and wrinkling of surface precipitates. Taken together, the work advances our ability to diagnose bitumen samples noninvasively by clearly distinguishing surface from bulk microstructure.

5.
J Microsc ; 271(3): 282-292, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29786842

RESUMEN

We use near-infrared dark-field optical microscopy to probe isothermal time variation of the volume fraction of naturally-occurring, subsurface microstructures in PG 64-22 asphalt binders at temperature T=30∘C, following a rapid heating (cooling) increment |ΔT|=20∘C from initial temperature T0=10∘C(50∘C). We compare these microstructure variations with isothermal time variations of the magnitude |G30∗(t)| of the bulk complex shear modulus measured for identical sample conditions with a Dynamic Shear Rheometer. The main findings are: (1) Microstructure volume fraction (inferred from intensity I(t) of near-infrared optical scatter) and |G∗(t)| both continue to change appreciably long after measurable changes of binder temperature cease. Moreover, delayed time variations in I(t) and |G∗(t)| (2) correlate closely with each other; (3) evolve on three distinct time scales - several minutes, ∼1 h, >1 day; (4) depend on binder aging; (5) are more pronounced after a cooling step (ΔT=-20∘C) than after a heating step (ΔT=+20∘C); and (6) account for hysteresis in I(t) and |G∗(t)| curves observed during heating-cooling cycles.

6.
Opt Lett ; 41(23): 5503-5506, 2016 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-27906224

RESUMEN

We present an analytical formalism elucidating how information is stored in chirped optical probes by describing the effects of sinusoidal temporal modulations on the electric field. We show that the modulations produce spectral sidebands which can be interpreted as temporal sidebands due to the time-wavelength mapping, an effect we call temporally encoded spectral shifting (TESS). A derivation is presented for the case of chirped-pulse spectral interferometry showing how to recover both the amplitude and the periodicity of the modulation from a Fourier transform of the interferogram. The TESS effect, which provides an intuitive picture for interpreting pump-probe experiments with chirped pulses, is illustrated for probing wakefields from a laser-plasma accelerator.

7.
J Microsc ; 262(3): 216-25, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-26594842

RESUMEN

We introduce noncontact optical microscopy and optical scattering to characterize asphalt binder microstructure at temperatures ranging from 15°C to 85°C for two compositionally different asphalt binders. We benchmark optical measurements against rheometric measurements of the magnitude of the temperature-dependent bulk complex shear modulus |G*(T)|. The main findings are: (1) Elongated (∼5 × 1 µm), striped microstructures (known from AFM studies as 'bees' because they resemble bumble-bees) are resolved optically, found to reside primarily at the surface and do not reappear immediately after a single heating-cooling cycle. (2) Smaller (∼1 µm(2) ) microstructures with no observable internal structure (hereafter dubbed 'ants'), are found to reside primarily in the bulk, to persist after multiple thermal cycles and to scatter light strongly. Optical scattering from 'ants' decreases to zero with heating from 15°C to 65°C, but recovers completely upon cooling back to 15°C, albeit with distinct hysteresis. (3) Rheometric measurements of |G*(T)| reveal hysteresis that closely resembles that observed by optical scatter, suggesting that thermally driven changes in microstructure volume fraction cause corresponding changes in |G*(T)|.

8.
Phys Rev Lett ; 113(8): 085001, 2014 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-25192102

RESUMEN

We visualize ps-time-scale evolution of an electron density bubble--a wake structure created in atmospheric density plasma by an intense ultrashort laser pulse--from the phase "streak" that the bubble imprints onto a probe pulse that crosses its path obliquely. Phase streaks, recovered in one shot using frequency-domain interferometric techniques, reveal the formation, propagation, and coalescence of the bubble within a 3 mm long ionized helium gas target. 3D particle-in-cell simulations validate the observed density-dependent bubble evolution, and correlate it with the generation of a quasimonoenergetic ∼ 100 MeV electron beam. The results provide a basis for understanding optimized electron acceleration at a plasma density n(e) ≈ 2 × 10(19) cm(-3), inefficient acceleration at lower density, and dephasing limits at higher density.

9.
Nat Commun ; 15(1): 4037, 2024 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-38740793

RESUMEN

Laser-driven plasma accelerators provide tabletop sources of relativistic electron bunches and femtosecond x-ray pulses, but usually require petawatt-class solid-state-laser pulses of wavelength λL ~ 1 µm. Longer-λL lasers can potentially accelerate higher-quality bunches, since they require less power to drive larger wakes in less dense plasma. Here, we report on a self-injecting plasma accelerator driven by a long-wave-infrared laser: a chirped-pulse-amplified CO2 laser (λL ≈ 10 µm). Through optical scattering experiments, we observed wakes that 4-ps CO2 pulses with < 1/2 terawatt (TW) peak power drove in hydrogen plasma of electron density down to 4 × 1017 cm-3 (1/100 atmospheric density) via a self-modulation (SM) instability. Shorter, more powerful CO2 pulses drove wakes in plasma down to 3 × 1016 cm-3 that captured and accelerated plasma electrons to relativistic energy. Collimated quasi-monoenergetic features in the electron output marked the onset of a transition from SM to bubble-regime acceleration, portending future higher-quality accelerators driven by yet shorter, more powerful pulses.

10.
Opt Lett ; 38(23): 5157-60, 2013 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-24281534

RESUMEN

We demonstrate a single-shot method of visualizing the evolution of light-speed, laser-generated structures as they propagate over hundreds of Rayleigh lengths (typically ≥10 cm) through a tenuous medium. An ultrashort probe pulse crosses the object's path at a small angle (θ<5°) and a specific time delay. Copies of the phase-modulated probe are then relay-imaged to separate detectors from selected object planes along the propagation path. A phase-contrast technique based on Kerr effect and nonlinear absorption converts phase to intensity modulation, improving sensitivity in tenuous media. A continuous record of the probe phase modulation along the propagation path is reconstructed.

11.
Rev Sci Instrum ; 93(4): 043102, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35489906

RESUMEN

We report the development of a multipurpose differential x-ray calorimeter with a broad energy bandwidth. The absorber architecture is combined with a Bayesian unfolding algorithm to unfold high energy x-ray spectra generated in high-intensity laser-matter interactions. Particularly, we show how to extract absolute energy spectra and how our unfolding algorithm can reconstruct features not included in the initial guess. The performance of the calorimeter is evaluated via Monte Carlo generated data. The method accuracy to reconstruct electron temperatures from bremsstrahlung is shown to be 5% for electron temperatures from 1 to 50 MeV. We study bremsstrahlung generated in solid target interaction showing an electron temperature of 0.56 ± 0.04 MeV for a 700 µm Ti titanium target and 0.53 ± 0.03 MeV for a 50 µm target. We investigate bremsstrahlung from a target irradiated by laser-wakefield accelerated electrons showing an endpoint energy of 551 ± 5 MeV, inverse Compton generated x rays with a peak energy of 1.1 MeV, and calibrated radioactive sources. The total energy range covered by all these sources ranges from 10 keV to 551 MeV.

12.
Community Dent Health ; 28(1): 34-9, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21485232

RESUMEN

OBJECTIVE: To estimate the potential reduction in dental caries among 5-6-year-old children in a city in the South West of England after six years of water fluoridation. METHOD: Thirteen out of 35 inner city wards and seven out of 43 outer city wards (sharing the same water supply) having the highest mean dmft of 5-6-year-olds (recorded in a census survey in 2005/6) and/or highest indexes of multiple deprivation (IMD) were the principal focal point. Population demographic data and 5-6-year-old caries prevalence and experience were examined. Mean IMD scores and aggregated, weighted mean values for dmft and caries prevalence were referred to previously published regression analyses of caries levels plotted against IMD for 34 fluoridated (F) and 233 non-fluoridated (NF) health districts in England in order to estimate potential caries reductions. RESULTS: Mean dmft of 5-6-year-olds in the 20 wards with the highest caries levels and/or social deprivation was 2.10 (95% CI 1.87, 2.33) and caries prevalence 49% (95% CI 47%, 52%). In three wards, mean dmft exceeded 2.60. Population of the selected wards was approximately 210,800 with a mean IMD score of 33.70 As a conservative estimate, after six years of fluoridation a caries reduction of > 40% could be expected in 5-6-year-olds for the conurbation overall and for the 20 high caries/high IMD wards, with a gain of 12 percentage points in the absolute proportion caries-free. The overall population of the 78 wards served by the three relevant water treatment works identified was approximately 700,000. CONCLUSIONS: On the basis of current caries levels and population demographics, it appears that a comprehensive fluoridation scheme covering the inner and outer city districts would substantially improve the dental health of the city's children.


Asunto(s)
Caries Dental/prevención & control , Fluoruración , Planificación en Salud/métodos , Niño , Preescolar , Intervalos de Confianza , Índice CPO , Caries Dental/epidemiología , Inglaterra/epidemiología , Predicción , Humanos , Funciones de Verosimilitud , Prevalencia , Carencia Psicosocial , Análisis de Regresión , Medición de Riesgo , Población Urbana
13.
Artículo en Alemán | MEDLINE | ID: mdl-21887616

RESUMEN

OBJECTIVE: To review four key topics pertaining to the oral health of the United Kingdom (UK): (1) provision of state-funded dentistry, (2) trends in oral health, (3) dental caries prevention, and (4) determinants of dental health. METHODS: Data were abstracted, mainly from peer-reviewed publications in the literature. Information was updated where appropriate. RESULTS: Since the 1948 inception of the National Health Service (NHS) and its General Dental Service (GDS), the system of providing dentistry has evolved in response to changing fiscal and health circumstances. Since the 1970s, the oral health of the population, both children's dental decay experience and the decline adult tooth loss, has improved steadily and substantially. Approaches towards prevention are discussed and the dominant position of water fluoridation highlighted. The determinants of dental health are analysed. CONCLUSION: Dental caries experience of children in the UK and the rest of Europe is highly correlated with national wealth as are two other significant determinants: fluoride toothpaste and sugar consumption. The activity of dental professionals appears to have only a limited influence on levels of oral health. There is reason to believe that UK water fluoridation coverage may broaden.


Asunto(s)
Atención Odontológica/tendencias , Caries Dental/prevención & control , Medicina Estatal/tendencias , Adulto , Niño , Comparación Transcultural , Estudios Transversales , Índice CPO , Caries Dental/epidemiología , Fluoruración/tendencias , Humanos , Salud Bucal/tendencias , Factores Socioeconómicos , Reino Unido
14.
Sci Rep ; 11(1): 14368, 2021 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-34257331

RESUMEN

We reconstruct spectra of secondary X-rays from a tunable 250-350 MeV laser wakefield electron accelerator from single-shot X-ray depth-energy measurements in a compact (7.5 × 7.5 × 15 cm), modular X-ray calorimeter made of alternating layers of absorbing materials and imaging plates. X-rays range from few-keV betatron to few-MeV inverse Compton to > 100 MeV bremsstrahlung emission, and are characterized both individually and in mixtures. Geant4 simulations of energy deposition of single-energy X-rays in the stack generate an energy-vs-depth response matrix for a given stack configuration. An iterative reconstruction algorithm based on analytic models of betatron, inverse Compton and bremsstrahlung photon energy distributions then unfolds X-ray spectra, typically within a minute. We discuss uncertainties, limitations and extensions of both measurement and reconstruction methods.

15.
Opt Lett ; 35(24): 4087-9, 2010 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-21165098

RESUMEN

We demonstrate a frequency-domain streak camera (FDSC) that captures the picosecond time evolution of luminal-velocity refractive index structures in a single shot. In our prototype FDSC, a probe-reference pulse pair propagates obliquely to a subpicosecond pump pulse that creates an evolving nonlinear index structure in glass, supplementing a conventional frequency-domain holographic probe-reference pair that copropagates with the pump. A single spectrometer acquires data from both pairs via spatial or temporal multiplexing, demonstrating the feasibility of a compact frequency-domain tomographic system in which a single spectrometer processes data from multiple probing angles.

16.
Phys Rev Lett ; 104(13): 134801, 2010 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-20481887

RESUMEN

Electron density bubbles--wake structures generated in plasma of density n(e) approximately 10(19) cm(-3) by the light pressure of intense ultrashort laser pulses--are shown to reshape weak copropagating probe pulses into optical "bullets." The bullets are reconstructed using frequency-domain interferometric techniques in order to visualize bubble formation. Bullets are confined in three dimensions to plasma-wavelength size, and exhibit higher intensity, broader spectrum and flatter temporal phase than surrounding probe light, evidence of their compression by the bubble. Bullets observed at 0.8 approximately < n(e) approximately < 1.2x10(19) cm(-3) provide the first observation of bubble formation below the electron capture threshold. At higher n(e), bullets appear with high shot-to-shot stability together with relativistic electrons that vary widely in spectrum, and help relate bubble formation to fast electron generation.

17.
Nat Commun ; 11(1): 4753, 2020 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-32958741

RESUMEN

Metre-scale plasma wakefield accelerators have imparted energy gain approaching 10 gigaelectronvolts to single nano-Coulomb electron bunches. To reach useful average currents, however, the enormous energy density that the driver deposits into the wake must be removed efficiently between shots. Yet mechanisms by which wakes dissipate their energy into surrounding plasma remain poorly understood. Here, we report picosecond-time-resolved, grazing-angle optical shadowgraphic measurements and large-scale particle-in-cell simulations of ion channels emerging from broken wakes that electron bunches from the SLAC linac generate in tenuous lithium plasma. Measurements show the channel boundary expands radially at 1 million metres-per-second for over a nanosecond. Simulations show that ions and electrons that the original wake propels outward, carrying 90 percent of its energy, drive this expansion by impact-ionizing surrounding neutral lithium. The results provide a basis for understanding global thermodynamics of multi-GeV plasma accelerators, which underlie their viability for applications demanding high average beam current.

18.
Community Dent Health ; 26(1): 5-11, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19385433

RESUMEN

OBJECTIVE: To provide a tool for public health planners to estimate the potential improvement in dental caries in children that might be expected in a region if its water supply were to be fluoridated. BASIC RESEARCH DESIGN: Recent BASCD (British Association for the Study of Community Dentistry) dental epidemiological data for caries in 5- and 11-year-old children in English primary care trusts in fluoridated and non-fluoridated areas were analysed to estimate absolute and relative improvement in dmft/DMFT and caries-free measures observed in England. Where data were sufficient for testing significance this analysis included the effect of different levels of deprivation. RESULTS: A table of observed improvements was produced, together with an example of how that table can be used as a tool for estimating the expected improvement in caries in any specific region of England. Observed absolute improvements and 95% confidence intervals were: for 5-year-olds reduction in mean dmft 0.56 (0.38, 0.74) for IMD 12, 0.73 (0.60, 0.85) for IMD 20, and 0.94 (0.76, 1.12) for IMD 30, with 12% (9%, 14%) more children free of caries; for 11-year-olds reduction in mean DMFT 0.12 (0.04, 0.20) for IMD 12, 0.19 (0.13, 0.26) for IMD 20, 0.29 (0.18, 0.40) and for IMD 30, with 8% (5%, 11%) more children free from caries. CONCLUSIONS: The BASCD data taken together with a deprivation measure are capable of yielding an age-specific, 'intention to treat' model of water fluoridation that can be used to estimate the potential effect on caries levels of a notional new fluoridation scheme in an English region.


Asunto(s)
Susceptibilidad a Caries Dentarias , Caries Dental/prevención & control , Fluoruración/normas , Planificación en Salud/métodos , Niño , Preescolar , Estudios Transversales , Índice CPO , Caries Dental/epidemiología , Fluoruración/métodos , Predicción , Humanos , Valor Predictivo de las Pruebas , Salud Pública , Medición de Riesgo , Reino Unido/epidemiología
19.
Community Dent Health ; 25(2): 70-8, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18637317

RESUMEN

OBJECTIVE: To investigate, from current cross-sectional data, the relationships between dental caries experience of 12-year-old children in 29 countries of Europe and four independent variables: national wealth (GDP), expressed as purchasing power parity (PPP x 1,000US$)/ capita/year; population per active dentist; sugar consumption, expressed as Kg/capita/year; and volume sales of toothpaste, expressed as litres/capita/year. METHOD: Most of the data were abstracted from relevant websites. Information on toothpaste sales was from personal communication and obtainable for 16 countries of Western Europe only. Relationships were examined using Spearman's rank correlation method. RESULTS: Mean DMFT showed a strong negative association with national GDP (rho = -0.729, p < 0.01), whilst toothpaste sales showed a statistically significant positive association with GDP (rho = 0.599, p < 0.05) as did sugar consumption (rho = 0.575, p < 0.01). Paradoxically, caries experience yielded a strong negative correlation with sugar consumption (rho = -0.561, p < 0.01) such that ranked increases in mean DMFT were significantly associated with decreasing levels of sugar consumption. None of the other rank correlations was statistically significant. CONCLUSIONS: Unavoidable shortcomings of the available data and their incompleteness meant that any conclusions that could be drawn were speculative. A possible explanation for the anomalous association of low mean DMFT with high sugar consumption in Western Europe is that the extensive use of, mainly fluoride containing, toothpaste neutralises the potential damage from high sugar consumption. Use of sugar principally as a commercial food or drink additive in modern times, with potential for buffering of its acidic fermentation products, together with a possibly more rapid oral clearance of sugar in additive form, may also be a contributory factor.


Asunto(s)
Caries Dental/epidemiología , Niño , Estudios Transversales , Índice CPO , Odontólogos/provisión & distribución , Sacarosa en la Dieta/economía , Economía , Europa (Continente)/epidemiología , Humanos , Modelos Lineales , Prevalencia , Pastas de Dientes/economía
20.
Health Technol Assess ; 10(14): 1-144, iii-iv, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16707071

RESUMEN

OBJECTIVES: To use a decision-analytic model to determine the incremental costs and outcomes of alternative oral cancer screening programmes conducted in a primary care environment. DESIGN: The cost-effectiveness of oral cancer screening programmes in a number of primary care environments was simulated using a decision analysis model. Primary data on actual resource use and costs were collected by case note review in two hospitals. Additional data needed to inform the model were obtained from published costs, from systematic reviews and by expert opinion using the Trial Roulette approach. The value of future research was determined using expected value of perfect information (EVPI) for the decision to screen and for each of the model inputs. SETTING: Hypothetical screening programmes conducted in a number of primary care settings. Eight strategies were compared: (A) no screen; (B) invitational screen--general medical practice; (C) invitational screen--general dental practice; (D) opportunistic screen--general medical practice; (E) opportunistic screen--general dental practice; (F) opportunistic high-risk screen--general medical practice; (G) opportunistic high-risk screen--general dental practice; and (H) invitational screen--specialist. PARTICIPANTS: A hypothetical population over the age of 40 years was studied. MAIN OUTCOME MEASURES: The main measures were mean lifetime costs and quality-adjusted life-years (QALYs) of each alternative screening scenario and incremental cost-effectiveness ratios (ICERs) to determine the additional costs and benefits of each strategy over another. RESULTS: No screening (strategy A) was always the cheapest option. Strategies B, C, E and H were never cost-effective and were ruled out by dominance or extended dominance. Of the remaining strategies, the ICER for the whole population (age 49-79 years) ranged from pound 15,790 to pound 25,961 per QALY. Modelling a 20% reduction in disease progression always gave the lowest ICERs. Cost-effectiveness acceptability curves showed that there is considerable uncertainty in the optimal decision identified by the ICER, depending on both the maximum amount that the NHS may be prepared to pay and the impact that treatment has on the annual malignancy transformation rate. Overall, however, high-risk opportunistic screening by a general dental or medical practitioner (strategies F and G) may be cost-effective. EVPIs were high for all parameters with population values ranging from pound 8 million to pound 462 million. However, the values were significantly higher in males than females but also varied depending on malignant transformation rate, effects of treatment and willingness to pay. Partial EVPIs showed the highest values for malignant transformation rate, disease progression, self-referral and costs of cancer treatment. CONCLUSIONS: Opportunistic high-risk screening, particularly in general dental practice, may be cost-effective. This screening may more effectively be targeted to younger age groups, particularly 40-60 year olds. However, there is considerable uncertainty in the parameters used in the model, particularly malignant transformation rate, disease progression, patterns of self-referral and costs. Further study is needed on malignant transformation rates of oral potentially malignant lesions and to determine the outcome of treatment of oral potentially malignant lesions. Evidence has been published to suggest that intervention has no greater benefit than 'watch and wait'. Hence a properly planned randomised controlled trial may be justified. Research is also needed into the rates of progression of oral cancer and on referral pathways from primary to secondary care and their effects on delay and stage of presentation.


Asunto(s)
Tamizaje Masivo/economía , Neoplasias de la Boca/diagnóstico , Lesiones Precancerosas/diagnóstico , Atención Primaria de Salud , Anciano , Análisis Costo-Beneficio , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Neoplasias de la Boca/patología , Años de Vida Ajustados por Calidad de Vida , Medicina Estatal , Reino Unido
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