Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial.

BACKGROUND: Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED-based smoking cessation intervention can help people to quit smoking. METHODS: In this multicentre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services). The primary outcome was biochemically validated abstinence at 6 months. RESULTS: An intention-to-treat analysis included 972 of 1443 people screened for inclusion (484 in the intervention group, 488 in the control group). Of 975 participants randomised, 3 were subsequently excluded, 17 withdrew and 287 were lost to follow-up. The 6-month biochemically-verified abstinence rate was 7.2% in the intervention group and 4.1% in the control group (relative risk 1.76; 95% CI 1.03 to 3.01; p=0.038). Self-reported 7-day abstinence at 6 months was 23.3% in the intervention group and 12.9% in the control group (relative risk 1.80; 95% CI 1.36 to 2.38; p<0.001). No serious adverse events related to taking part in the trial were reported. CONCLUSIONS: An opportunistic smoking cessation intervention comprising brief advice, an e-cigarette starter kit and referral to stop smoking services is effective for sustained smoking abstinence with few reported adverse events. TRIAL REGISTRATION NUMBER: NCT04854616.

What Therapeutic Biomarkers in Gastro-Esophageal Junction and Gastric Cancer Should a Pathologist Know About?

Malignancies of upper gastrointestinal tract are aggressive, and most locally advanced unresectable and metastatic cancers are managed by a combination of surgery and neoadjuvant/adjuvant chemotherapy and radiotherapy. Current therapeutic recommendations include targeted therapies based on biomarker expression of an individual tumor. All G/gastro-esophageal junction (GEJ) cancers should be tested for HER2 status as a reflex test at the time of diagnosis. Currently, testing for PDL 1 and mismatch repair protein status is optional. HER2 testing is restricted to adenocarcinomas only and endoscopic biopsies, resections, or cellblocks. Facilities should be available for performing validated immunohistochemical stains and in-situ hybridization techniques, and importantly, pathologists should be experienced with preanalytical and analytical issues and scoring criteria. Genomic profiling via next-generation sequencing (NGS) is another strategy that assess numerous mutations and other molecular events simultaneously, including HER2 amplification, MSS status, tumor mutation burden, and neurotrophic tropomyosin-receptor kinases gene fusions.

Quantifying the contribution of mangroves to local fish consumption in Indonesia: a cross-sectional spatial analysis.

BACKGROUND: Indonesia has lost more mangroves than any other country. The importance of mangroves for carbon storage and biodiversity is well recognised, but much less is known about what they contribute to the communities living near them who are called on to protect them. Malnutrition in Indonesia is high, with more than a third of children stunted, partly due to poor diets. Fish are nutrient-rich and are the most widely consumed animal source food in Indonesia, making the relationship between mangroves and fish consumption of great importance. Aquaculture is also tremendously important for fish production in Indonesia and has replaced large areas of mangroves over the last two decades. METHODS: We performed a cross-sectional, spatial analysis in this study. We combined data on fish consumption for rural Indonesian coastal households from the Indonesian National Socioeconomic Survey with spatial data on mangrove forest and aquaculture area from the Indonesian Ministry of Environment and Forestry to create a cross-sectional spatial dataset. Using a mixed-effects regression model, we estimated to what extent living in proximity to different densities of mangroves and aquaculture was associated with fresh fish consumption for rural coastal households. FINDINGS: Our sample included 6741 villages with 107 486 households in 2008. The results showed that rural coastal households residing near high-density mangroves consumed 28% (134/477) more fresh fish and other aquatic animals, and those residing near medium-density mangroves consumed 19% (90/477) more fresh fish and other aquatic animals, than coastal households who did not live near mangroves. Coastal households that lived near high-density aquaculture consumed 2% (9/536) more fresh fish, and those that lived near medium-density aquaculture consumed 1% (3/536) less, than other rural coastal households. INTERPRETATION: Mangroves contribute substantially to the food security and nutrition of coastal communities in Indonesia. This finding means that the conservation of mangroves is important not only for carbon storage and biodiversity, but also for the communities living near them. Aquaculture does not appear to offer similar food security benefits. FUNDING: Bureau for Economic Growth, Education, and Environment, United States Agency for International Development.

Fluid biomarkers and neuroimaging in mild traumatic brain injury: current uses and potential future directions for clinical use in emergency medicine.

Mild traumatic brain injury is a common presentation to the emergency department, with current management often focusing on determining whether a patient requires a CT head scan and/or neurosurgical intervention. There is a growing appreciation that approximately 20%-40% of patients, including those with a negative (normal) CT, will develop ongoing symptoms for months to years, often termed post-concussion syndrome. Owing to the requirement for improved diagnostic and prognostic mechanisms, there has been increasing evidence concerning the utility of both imaging and blood biomarkers.Blood biomarkers offer the potential to better risk stratify patients for requirement of neuroimaging than current clinical decisions rules. However, improved assessment of the clinical utility is required prior to wide adoption. MRI, using clinical sequences and advanced quantitative methods, can detect lesions not visible on CT in up to 30% of patients that may explain, at least in part, some of the ongoing problems. The ability of an acute biomarker (be it imaging, blood or other) to highlight those patients at greater risk of ongoing deficits would allow for greater personalisation of follow-up care and resource allocation.We discuss here both the current evidence and the future potential clinical usage of blood biomarkers and advanced MRI to improve diagnostic pathways and outcome prediction following mild traumatic brain injury.

Home range ecology of Indian rock pythons (Python molurus) in Sathyamangalam and Mudumalai Tiger Reserves, Tamil Nadu, Southern India.

The Indian rock pythons (Python molurus) are classified as a near-threatened snake species by the International Union for the Conservation of Nature and Natural Resources (IUCN); they are native to the Indian subcontinent and have experienced population declines caused primarily by poaching and habitat loss. We hand-captured the 14 rock pythons from villages, agricultural lands, and core forests to examine the species' home ranges. We later released/translocated them in different kilometer ranges at the Tiger Reserves. From December 2018 to December 2020, we obtained 401 radio-telemetry locations, with an average tracking duration of (444 ± 212 days), and a mean of 29 ± SD 16 data points per individual. We quantified home ranges and measured morphometric and ecological factors (sex, body size, and location) associated with intraspecific differences in home range size. We analyzed the home ranges of rock pythons using Auto correlated Kernel Density Estimates (AKDE). AKDEs can account for the auto-correlated nature of animal movement data and mitigate against biases stemming from inconsistent tracking time lags. Home range size varied from 1.4 ha to 8.1 km2 and averaged 4.2 km2. Differences in home range sizes could not be connected to body mass. Initial indications suggest that rock python home ranges are larger than other pythons.

Impact of adhesive application errors on dentin bond strength of resin composite.

Objectives: To investigate the impact of adhesive application errors on dentin bond strength of resin composite. Material and Methods: 165 extracted permanent human molars were ground to mid-coronal dentin. The dentin specimens were treated with one of three adhesive systems (OptiBond FL, Clearfil SE, Scotchbond Universal) either according to manufacturer's instructions or with systematic errors in the application procedure and before application of resin composite (Filtek Z250). After storage (37 °C, 100% humidity, 24 h) shear bond strength (SBS) was measured and data analysed with either one-way ANOVA followed by Tukey tests (OptiBond FL, Scotchbond Universal, control groups) or Kruskal-Wallis followed by Wilcoxon tests (Clearfil SE). Finally, the failure mode of all specimens was assessed. Results: With OptiBond FL and Clearfil SE omitted application (p ≤ 0.0001) as well as no evaporation (p ≤ 0.001) of the solvents in the primer significantly reduced the SBS. Omitted application of the adhesive, respectively the bond, had a negative influence on the SBS of Clearfil SE (p < 0.0001), but not of OptiBond FL (p = 0.776). With Scotchbond Universal, no evaporation of the solvents (p < 0.0001) as well as no light-cure (p = 0.0004) had a significant negative influence on the SBS. Using the adhesive systems according to manufacturer's instructions, Clearfil SE achieved significantly lower SBS than OptiBond FL and Scotchbond Universal (p = 0.0027). Adhesive failure at the dentin surface was generally the most frequent failure mode observed. Conclusion: All three adhesive systems tested were sensitive to application errors. For optimal result and longest possible durability of resin restorations, clinicians should strictly adhere to the manufacturer's instructions.

Bioinspired morphing fins to provide optimal maneuverability, stability, and response to turbulence in rigid hull AUVs.

By adopting bioinspired morphing fins, we demonstrate how to achieve good directional stability, exceptional maneuverability, and minimal adverse response to turbulent flow, properties that are highly desirable for rigid hull AUVs, but are presently difficult to achieve because they impose contradictory requirements. We outline the theory and design for switching between operating with sufficient stability that ensures a steady course in the presence of disturbances, with low corrective control action; reverting to high maneuverability to execute very rapid course and depth changes, improving turning rate by 25% up to 50%; and ensuring at all times that angular responses to external turbulence are minimized. We then demonstrate the developments through tests on a 1 m long autonomous underwater vehicle, namedMorpheus. The vehicle is capable of dynamically changing its stability-maneuverability qualities by using tuna-inspired morphing fins, which can be deployed, deflected and retracted, as needed. A series of free-swimming experiments and maneuvering simulations, combined with mathematical analysis, led to the design of optimal retractable morphing fins.

Blood loss and transfusion rates following total hip arthroplasty: a multivariate analysis.

This study aimed to identify factors that inde- pendently predict increased rates of transfusion following total hip arthroplasty (THA) surgery. A retrospective analysis of all patients undergoing THA surgery over 12 months was performed. Electronic operative records were analysed to determine the following patient factors: American Society of Anesthesiologists (ASA) grade, body mass index (BMI), co-morbidities, indication for surgery, surgical technique, type of implant used, haematological markers, hospital length of stay (LOS) and complications. A total of 244 patients were included. There were 141 females (58%) and 103 males (42%). The median age was 65±12. The median pre-operative blood volume was 4500mls (IQR; 4000-5200). The median blood loss was 1069mls (IQR; 775-1390). The total number of patients requiring transfusion was 28 (11%), with a median of two units being transfused. Pre-operative haemoglobin (p<0.001) level, haematocrit (p<0.001) level and weight (p=0.016) were found to be predictive of transfusion requirement as well as ASA grade (p=0.005). Application of an intra-operative surgical drain was associated with higher rates of transfusion (p<0.001). Our study strengthens the evidence that pre-operative haemoglobin and haematocrit levels are valuable predictors of patients requiring transfusion. Additionally, ASA grade may be viewed as a helpful factor in predicting risk of transfusion. A strategy incorporating pre-operative optimisation of modifiable factors may reduce rates of transfusion requirement.

Malayan kraits (Bungarus candidus) show affinity to anthropogenic structures in a human dominated landscape.

Animal movement can impact human-wildlife conflict by influencing encounter and detection rates. We assess the movement and space use of the highly venomous and medically important Malayan krait (Bungarus candidus) on a suburban university campus. We radio-tracked 14 kraits for an average of 114 days (min: 19, max: 218), during which we located individuals an average of 106 times (min: 21, max: 229) each. Most individuals displayed some level of attraction to buildings (n = 10) and natural areas (n = 12); we identified a similar unambiguous pattern of attraction to buildings and natural areas at the population level (of our sample). Snakes remained in shelter sites for long durations (max: 94 days) and revisited sites on average every 15.45 days. Over 50% of locations were within human settlements and 37.1% were associated with buildings. We found generally seasonal patterns of activity, with higher activity in wet seasons, and lower activity in the hot season. These results show frequent proximity between Malayan kraits and humans at the university; thereby, suggesting a near constant potential for human-wildlife conflict. Despite the fact that no snakebites from this species occurred at the university during our study period, substantial education and awareness training should be considered to ensure continued coexistence on campus.

Chickensplash! Exploring the health concerns of washing raw chicken.

The Food and Drug Administration recommends against washing raw chicken due to the risk of transferring dangerous food-borne pathogens through splashed drops of water. Many cooks continue to wash raw chicken despite this warning, however, and there is a lack of scientific research assessing the extent of microbial transmission in splashed droplets. Here, we use large agar plates to confirm that bacteria can be transferred from the surface of raw chicken through splashing. We also identify and create a phylogenetic tree of the bacteria present on the chicken and the bacteria transferred during splashing. While no food-borne pathogens were identified, we note that organisms in the same genera as pathogens were transferred from the chicken surface through these droplets. Additionally, we show that faucet height, flow type, and surface stiffness play a role in splash height and distance. Using high-speed imaging to explore splashing causes, we find that increasing faucet height leads to a flow instability that can increase splashing. Furthermore, splashing from soft materials such as chicken can create a divot in the surface, leading to splashing under flow conditions that would not splash on a curved, hard surface. Thus, we conclude that washing raw chicken does risk pathogen transfer and cross-contamination through droplet ejection, and that changing washing conditions can increase or decrease the risk of splashing.

How do King Cobras move across a major highway? Unintentional wildlife crossing structures may facilitate movement.

Global road networks continue to expand, and the wildlife responses to these landscape-level changes need to be understood to advise long-term management decisions. Roads have high mortality risk to snakes because snakes typically move slowly and can be intentionally targeted by drivers.We investigated how radio-tracked King Cobras (Ophiophagus hannah) traverse a major highway in northeast Thailand, and if reproductive cycles were associated with road hazards.We surveyed a 15.3 km stretch of Highway 304 to determine if there were any locations where snakes could safely move across the road (e.g., culverts and bridges). We used recurse analyses to detect possible road-crossing events, and used dynamic Brownian Bridge Movement Models (dBBMMs) to show movement pathways association with possible unintentional crossing structures. We further used Integrated Step Selection Functions (ISSF) to assess seasonal differences in avoidance of major roads for adult King Cobras in relation to reproductive state.We discovered 32 unintentional wildlife crossing locations capable of facilitating King Cobra movement across the highway. While our dBBMMs broadly revealed underpasses as possible crossing points, they failed to identify specific underpasses used by telemetered individuals; however, the tracking locations pre- and post-crossing and photographs provided strong evidence of underpass use. Our ISSF suggested a lower avoidance of roads during the breeding season, although the results were inconclusive. With the high volume of traffic, large size of King Cobras, and a 98.8% success rate of crossing the road in our study (nine individuals: 84 crossing attempts with one fatality), we strongly suspect that individuals are using the unintentional crossing structures to safely traverse the road.Further research is needed to determine the extent of wildlife underpass use at our study site. We propose that more consistent integration of drainage culverts and bridges could help mitigate the impacts of roads on some terrestrial wildlife.

From Healthcare to Hiring: Impacts of Social and Public Policy on Disabled Veterans in the United States.

Part I of this paper considers the historical foundations, motivations, and evolution of veterans' disability and employment legislation in the United States. Utilizing disability and employment as its framework, Part II then defines, describes, and critiques contemporary policies for disabled veterans in the areas of federal employment protections and uses of Alternative Dispute Resolution (ADR) within the VA's disability decision review process. Part III discusses the roles played by disabled veterans and the federal government in policy reform, finding that both sides act as catalysts and barriers to legislative change. This paper concludes in Part IV, recommending legislation that integrates elements of disability care--currently under the auspices of the VA--into Medicare. Through this newly created insurance component, which this paper will call "Medicare Part V," disabled veterans will be eligible to access all hospitals and clinics currently accepting Medicare. This is anticipated to increase access to care in local facilities. Second, it is essential that the federal government devotes sufficient resources to conduct more longitudinal data collection studies, enabling a more comprehensive assessment of the transitional and employment resource needs of disabled veterans over time. Achieving a greater understanding of these needs may induce greater veteran participation rates in the labor force, benefiting employers and veterans alike. Finally, this paper calls for modernizing and optimizing the VA's claim appeals process by creating a secure online method of Alternative Dispute Resolution for appeals, specifically in Higher-Level Reviews (HLR's) of disability and compensation requests.

We are Family: A Feasibility and Acceptability Study of an HIV Prevention Intervention With the House Ball and Gay Family Communities.

BACKGROUND: Black and Latinx sexual minority youth are disproportionately affected by HIV. The House Ball and gay family communities encompass sexual and ethnic minority youth who form chosen families that promote protective HIV-related health behaviors. We conducted a small-scale trial of the We Are Family intervention, leveraging these existing social dynamics to address HIV. METHODS: From September 2018 to September 2019, we enrolled N = 118 for baseline and 6-month follow-up assessments. Eligible participants were 18 years or older, San Francisco Bay Area residents, members of a house or gay family or ball attendees in the past year, smartphone users, and sexually active. The intervention included one 2-hour in-person group session, community-level events, a mobile health app, and a dedicated service provider. RESULTS: Ninety-seven percent of our participants were people of color, 94% were retained through follow-up. 73% attended at least 1 group session, 100% used the mobile health app, and 56% attended a community-level event. Modest changes were observed baseline to follow-up: among all participants, any condomless anal intercourse past 3 months (74.6%-66.7%, P = 0.064); among HIV-negative participants (N = 82) HIV testing past 6 months (80.7%-87.2%, P = 0.166); among HIV-positive participants (N = 34) receiving HIV primary care past 6 months (64.5%-78.8%, P = 0.139), and adherent to ART past 30 days (22.6%-28.1%, P = 0.712). 86% would be willing to refer a friend to the app, and 65% found the app to be personally relevant. CONCLUSIONS: We Are Family reaches and retains its target population, is feasible, acceptable, and shows promise for improving HIV-related health behavior.

Tuberculosis in badgers where the bovine tuberculosis epidemic is expanding in cattle in England.

Bovine tuberculosis (bTB) is an important animal health and economic problem for the cattle industry and a potential zoonotic threat. Wild badgers (Meles meles) play a role on its epidemiology in some areas of high prevalence in cattle, particularly in the UK and Republic of Ireland and increasingly in parts of mainland Europe. However, little is known about the involvement of badgers in areas on the spatial edge of the cattle epidemic, where increasing prevalence in cattle is seen. Here we report the findings of a study of found-dead (mainly road-killed) badgers in six counties on the edge of the English epidemic of bTB in cattle. The overall prevalence of Mycobacterium tuberculosis complex (MTC) infection detected in the study area was 51/610 (8.3%, 95% CI 6.4-11%) with the county-level prevalence ranging from 15 to 4-5%. The MTC spoligotypes of recovered from badgers and cattle varied: in the northern part of the study area spoligotype SB0129 predominated in both cattle and badgers, but elsewhere there was a much wider range of spoligotypes found in badgers than in cattle, in which infection was mostly with the regional cattle spoligotype. The low prevalence of MTC in badgers in much of the study area, and, relative to in cattle, the lower density of sampling, make firm conclusions difficult to draw. However, with the exception of Cheshire (north-west of the study area), little evidence was found to link the expansion of the bTB epidemic in cattle in England to widespread badger infection.

Gaps in global wildlife trade monitoring leave amphibians vulnerable.

As the biodiversity crisis continues, we must redouble efforts to understand and curb pressures pushing species closer to extinction. One major driver is the unsustainable trade of wildlife. Trade in internationally regulated species gains the most research attention, but this only accounts for a minority of traded species and we risk failing to appreciate the scale and impacts of unregulated legal trade. Despite being legal, trade puts pressure on wild species via direct collection, introduced pathogens, and invasive species. Smaller species-rich vertebrates, such as reptiles, fish, and amphibians, may be particularly vulnerable to trading because of gaps in regulations, small distributions, and demand of novel species. Here, we combine data from five sources: online web searches in six languages, Convention on International Trade in Endangered Species (CITES) trade database, Law Enforcement Management Information System (LEMIS) trade inventory, IUCN assessments, and a recent literature review, to characterise the global trade in amphibians, and also map use by purpose including meat, pets, medicinal, and for research. We show that 1215 species are being traded (17% of amphibian species), almost three times previous recorded numbers, 345 are threatened, and 100 Data Deficient or unassessed. Traded species origin hotspots include South America, China, and Central Africa; sources indicate 42% of amphibians are taken from the wild. Newly described species can be rapidly traded (mean time lag of 6.5 years), including threatened and unassessed species. The scale and limited regulation of the amphibian trade, paired with the triptych of connected pressures (collection, pathogens, invasive species), warrants a re-examination of the wildlife trade status quo, application of the precautionary principle in regard to wildlife trade, and a renewed push to achieve global biodiversity goals.

In the last few decades, exotic pets have become much more common. In the UK in 2008, reptiles and amphibians were more popular than dogs, with over eight million in captivity. But while almost all pet cats and dogs are born and bred in captivity, exotic pets are often taken from the wild, putting species and their habitats at risk. An international trade agreement called the Convention on International Trade in Endangered Species (CITES) strives to prevent unsustainable animal trade. But to get CITES protection, species depend on data showing that wildlife trade threatens their survival. In addition, their range countries need to first propose them to be listed. For most wild animal species, there are no data on population size or population decline. In the case of amphibians, CITES regulates the trade of just 2.5% of species. This leaves the rest with no protection from overarching international trade regulations. To protect these animals, researchers need to find out which species are in trade, where they are coming from, and how many are already threatened. To address this, Hughes, Marshall and Strine combined data from five sources, including official CITES trade records, recent research and an online search for amphibian sales in six languages. The data showed evidence of trade in at least 1,215 amphibian species, representing 17% of all amphibians. The figure is three times higher than previous estimates. Of the species in trade, more than one in five is vulnerable to extinction, endangered, or critically endangered. For a further 100 of the traded species, data on population were unavailable. Moreover, analysis of the origins of traded individuals showed that around 42% came from the wild. Tropical parts of the world had the highest number of species in trade, but the data showed exchanges happening across the globe. Unsustainable wildlife trade can have devastating consequences for wild animals. It has already driven at least 21 reptile species to extinction, and data of amphibian species are unknown. To prevent further species going extinct, legal wildlife trade should follow the precautionary principle when it comes to wildlife trade. Rather than allowing people to trade a species until CITES regulates it, a blanket ban should come into force for species that have not been assessed or are threatened. Trade would be able to resume for a species only when assessments show that it would not cause major population decline, or secure, captive breeding facilities can be guaranteed.

Lessons from COVID-19-free Vanuatu: intensive health operations for Phase 1 of repatriation and quarantine, May-July 2020.

International borders to Vanuatu closed on 23 March 2020 due to the global COVID-19 pandemic. In May-July 2020, the Government of Vanuatu focused on the safe and timely return of citizens and residents while ensuring Vanuatu remained COVID-19 free. Under Phase 1 of repatriation, between 27 May and 23 June 2020, 1522 people arrived in the capital, Port Vila, and were placed in compulsory government-mandated 14-day quarantine in 15 hotels. Pre-arrival health operations included collection of repatriate information, quarantine facility assessments, training for personnel supporting the process, and tabletop and functional exercises with live scenario simulations. During quarantine, health monitoring, mental health assessments and psychosocial support were provided. All repatriates completed 14 days of quarantine. One person developed symptoms consistent with COVID-19 during quarantine but tested negative. Overall health operations were considered a success despite logistical and resource challenges. Lessons learnt were documented during a health sector after-action review held on 22 July 2020. Key recommendations for improvement were to obtain timely receipt of repatriate information before travel, limit the number of repatriates received and avoid the mixing of "travel cohorts," ensure sufficient human resources are available to support operations while maintaining other essential services, establish a command and control structure for health operations, develop training packages and deliver them to all personnel supporting operations, and coordinate better with other sectors to ensure health aspects are considered. These recommendations were applied to further improve health operations for subsequent repatriation and quarantine, with Phase 2 commencing on 1 August 2020.

Improving productivity, costs and environmental impact in International Eye Health Services: using the 'Eyefficiency' cataract surgical services auditing tool to assess the value of cataract surgical services.

OBJECTIVE: Though one of the most common surgeries, there is limited information on variability of practices in cataract surgeries. 'Eyefficiency' is a cataract surgical services auditing tool to help global units improve their surgical productivity and reduce their costs, waste generation and carbon footprint. The aim of the present research is to identify variability and efficiency opportunities in cataract surgical practices globally. METHODS AND ANALYSIS: 9 global cataract surgical facilities used the Eyefficiency tool to collect facility-level data (staffing, pathway steps, costs of supplies and energy use), and live time-and-motion data. A point person from each site gathered and reported data on 1 week or 30 consecutive cataract surgeries. Environmental life cycle assessment and descriptive statistics were used to quantify productivity, costs and carbon footprint. The main outcomes were estimates of productivity, costs, greenhouse gas emissions, and solid waste generation per-case at each site. RESULTS: Nine participating sites recorded 475 cataract extractions (a mix of phacoemulsification and manual small incision). Cases per hour ranged from 1.7 to 4.48 at single-bed sites and 1.47 to 4.25 at dual-bed sites. Average per-case expenditures ranged between £31.55 and £399.34, with a majority of costs attributable to medical equipment and supplies. Average solid waste ranged between 0.19 kg and 4.27 kg per phacoemulsification, and greenhouse gases ranged from 41 kg carbon dioxide equivalents (CO2e) to 130 kg CO2e per phacoemulsification. CONCLUSION: Results demonstrate the global diversity of cataract surgical services and non-clinical metrics. Eyefficiency supports local decision-making for resource efficiency and could help identify regional or global best practices for optimising productivity, costs and environmental impact of cataract surgery.

Usability of electronic health record systems in UK EDs.

BACKGROUND: The large volume of patients, rapid staff turnover and high work pressure mean that the usability of all systems within the ED is important. The transition to electronic health records (EHRs) has brought many benefits to emergency care but imposes a significant burden on staff to enter data. Poor usability has a direct consequence and opportunity cost in staff time and resources that could otherwise be employed in patient care. This research measures the usability of EHR systems in UK EDs using a validated assessment tool. METHODS: This was a survey completed by members and fellows of the Royal College of Emergency Medicine conducted during summer 2019. The primary outcome was the System Usability Scale Score, which ranges from 0 (worst) to 100 (best). Scores were compared with an internationally recognised measure of acceptable usability of 68. Results were analysed by EHR system, country, healthcare organisation and physician grade. Only EHR systems with at least 20 responses were analysed. RESULTS: There were 1663 responses from a total population of 8794 (19%) representing 192 healthcare organisations (mainly UK NHS), and 25 EHR systems. Fifteen EHR systems had at least 20 responses and were included in the analysis. No EHR system achieved a median usability score that met the industry standard of acceptable usability.The median usability score was 53 (IQR 35-68). Individual EHR systems' scores ranged from 35 (IQR 26-53) to 65 (IQR 44-80). CONCLUSION: In this survey, no UK ED EHR system met the internationally validated standard of acceptable usability for information technology.