Diagnosing Acute Heart Failure in Patients With Undifferentiated Dyspnea: A Lung and Cardiac Ultrasound (LuCUS) Protocol

Objectives The primary goal of this study was to determine accuracy for diagnosing acutely decompensated heart failure (ADHF) in the undifferentiated dyspneic emergency department (ED) patient using a lung and cardiac ultrasound (LuCUS) protocol. Secondary objectives were to determine if US findings acutely change management and if findings are more accurate than clinical gestalt. Methods This was a prospective, observational study of adult patients presenting to the ED with undifferentiated dyspnea. The intervention consisted of a 12-view LuCUS protocol performed by experienced emergency physician sonographers. The primary objective was measured by comparing US findings to the final diagnosis independently determined by two physicians blinded to the LuCUS result. Acute treatment changes based on US findings were tracked in real time through a standardized data collection form. Results Data on 99 patients were analyzed; ADHF was the final diagnosis in 36%. The LuCUS protocol had sensitivity of 83% (95% confidence interval [CI] = 67% to 93%), specificity of 83% (95% CI = 70% to 91%), positive likelihood ratio of 4.8 (95% CI = 2.7 to 8.3), and negative likelihood ratio of 0.20 (95% CI = 0.09 to 0.42). Forty-seven percent of patients had changes in acute management, and 42% had changes in acute treatment. Observed agreement for the LuCUS protocol was 93% between coinvestigators. Overall, accuracy improved by 20% (83% vs. 63%, 95% CI = 8% to 31% for the difference) over clinical gestalt alone. Conclusions The LuCUS protocol may accurately identify ADHF and may improve acute clinical management in dyspneic ED patients. This protocol has improved diagnostic accuracy over clinical gestalt alone

Global Prevalence of Tobacco Use in Adolescents and Its Adverse Oral Health Consequences

BACKGROUND: Smoking is associated with various systemic conditions and contributes to a huge financial burden to economies around the world. AIM: The study aimed to evaluate global data about the prevalence of tobacco use among male and female adolescents and to discuss smoking-related oral complications. METHODS: The prevalence data of tobacco use among adolescents (13-15 years) was retrieved from the World Health Organization (Global Health Observatory). The World Bank’s statistics about gross national income (GNI) per capita were used to categorise low-income, lower-middle-income, upper-middle-income, and high-income countries. PubMed, Web of Science, Scopus, and Embase databases were searched to gather updated evidence about the adverse consequences of smoking on oral health among adolescents. RESULTS: The prevalence of tobacco use was 19.33%, and there were 23.29% of male and 15.35% female smoker adolescents in 133 countries (p < 0.001). The highest prevalence of tobacco use in male (24.76%) and female (19.4) adolescents was found in high-income countries. Significantly higher proportions of male adolescents were smokers than female counterparts in low-income, lower-middle-income, and upper-middle-income (p < 0.001). However, there were no statistically significant differences in tobacco use between male and female adolescents in high-income countries. Low-income countries had the lowest prevalence (14.95%) of tobacco use, while high-income countries had the highest prevalence estimates (22.08). Gingivitis (72.8%), gingival bleeding (51.2%), oral malodor or halitosis (39.6%) is common oral conditions among smoker adolescents. Smoking habit is significantly associated with dental caries, periodontal disease, hairy tongue, smoking-related melanosis, and hyperkeratosis among adolescents. CONCLUSION: There was a high prevalence of tobacco use among male and female adolescents around the globe. Available evidence suggests a strong association between smoking and compromised oral health among adolescents. Globally, measures should be taken to prevent and control the menace of tobacco use to reduce systemic and oral complications

SANKHAHOLI (( Evolvulus alsinoides Linn.)): A REVIEW

ABSTRACT: The Sankhaholi (Evolvulus alsinoides Linn.) of family  Convolvulaceae which is commonly known as sankhpushpi, in traditional system of medicine including Unani Medicine. It is a perennial herb with a small woody branched root stock which contains alkaloids: shankhapushpine and evolvine. Fresh plant of sankhholi contains volatile oil. It also contains a yellow neutral fat, an organic acid and saline substances. Therapeutic uses of Sankhaholi Evolvulus alsinoides Linn, mentioned in the Unani Medicine are Alexiteric (Mufarreh), Cardiac  tonic  (Muqawwi-e Qalb), Brain tonic  (Muqawwi-e Dimag), Digestive (Hazim)  Musaffi-e- Khoon (Blood purifier),General tonic (Muqawwi-e-am), Diuretic (Mudirr-e-Baul), Anti Inflammatory (Muhallil-e-waram), Hypoglycemic (Dafa-e-Ziabitus), Antihypertensive (Dafye Imtella). It is also used in headache, asthma, hyperlipidemia etc. The present article reviews the pharmacological actions and therapeutic uses of Sankhaholi ( Evolvulus alsinoides Linn.) present in Unani literature supported with the available clinical and animal studies.Keywords: Sankhaholi Evolvulus alsinoides Linn. Sankhpushpi, Unani Medicin

Dundee Ready Educational Environment Measure Tool for Evaluating the Educational Environment: A Systematic Review and Meta-analysis

OBJECTIVE: The purpose of this systematic review was to study the literature evaluating the educational environment by using DREEM tool and compute overall mean DREEM score by using Meta-analysis. Further, variation in DREEM score was also studied by distributing studies into different time periods. MATERIALS AND METHODS: A systematic literature search was performed using PubMed and Web of Science databases, followed by review and analysis. All the studies which used DREEM as a tool, published from 1997 to December 2015 were included. Heterogeneity between the studies was assessed by I2-coefficient and Q-statistics. Where significant heterogeneity existed random effect, model was used. Egger’s symmetric test and Begg’s funnel plot was used to study possibility of publication bias. The PRISMA Guideline for systematics review was used. RESULTS: Out of 128 published DREEM studies, 43 passed the criteria and included in analysis. Overall mean DREEM score through Meta-analysis was 2.426 (95% confidence interval [CI]: 2.34-2.52). Studies were divided into two groups for analyzing the time effect. Mean score of the studies published during 1997 to 2009 (group 1) was 2.5 (95% confidence interval [CI]: 2.35-2.64) and for the studies from 2010 to 2015 (group 2) was 2.39 (95% confidence interval [CI]: 2.29-2.5). CONCLUSION: Overall DREEM score was more towards positive side than negative. Current review revealed that DREEM has not been used as predictor for achievement of any medical college instead it can be used to predict high and low achievers in a medical school. This review can signify DREEM to be suitable and consistent tool showing learning environment of institute and student’s prerequisites

Reasons for and Barriers to Attending Continuing Education Activities and Priorities for Different Dental Specialties

BACKGROUND: Continuing education (CE) activities help dentists update their knowledge and skills to ensure high standards of patient care. AIM: This study aimed to evaluate the reasons for and barriers to attending CE activities including the priorities for different dental specialities. METHODS: The study involves a cross-sectional research design. After statistical consultation, a questionnaire was distributed among 323 dental practitioners in the Eastern province of Saudi Arabia. The questionnaire was checked for face and content validity, and it was pilot-tested before its administration. RESULTS: The response rate was 79.5% as 257 of 323 dentists returned the questionnaire. Most dentists reported that they attended CE activities because of personal learning needs (67.3%) and career development (66.9%). Lack of clinical experience to effectively manage patients and the practice was the least common (15.2%) reason for attending CE activities. Esthetic dentistry (77.4%), restorative dentistry (70.8%), and endodontics (70%) were the three most preferred dental specialities for CE activities. Lack of time was the most common (69.3%) barrier to attending CE activities followed by the cost (62.6%) and the distance (57.2%). More male (n = 104) than female (n = 69) dentists believed personal learning needs a reason for attending CE activities (P = 0.01). Similarly, more male (n = 104) than female dentists (n = 68) considered lack of time a barrier (P = 0.046). CONCLUSION: Most dentists attended CE activities to fulfil their personal learning needs, and aesthetic dentistry was the most preferred dental speciality for CE activities. Lack of time and cost were important barriers to attending CE activities

An open label hepatoprotective activity of Jawārish bisbāsā in central obesity patients

Liver plays a major role in metabolism and excretion of xenobiotics. Liver dysfunction is a major health problem that challenges health care professionals, pharmaceutical industry and drug regulatory agencies. The most common symptoms are fatigue and discomfort in abdomen while in patients who are obese with BMI > 25, about one third have metabolic syndromes. The present clinical research was conducted in Regional Research Institute of Unani Medicine, Aligarh. The patients under trial were selected from GOPD of institute for obesity and it was observed that out of total registered patients’ approx 28% have elevated liver enzymes from its normal range without any sign and symptom of hepatitis etc. Total 23 patients were selected from the study whose liver enzymes (SGOT, SGPT and ALP) were high at the baseline. Unani pharmacopoeial drug Jawārish bisbāsā 7 g daily was prescribed with lukewarm water in the morning and evening empty stomach for 8 weeks. At the end of study the result were compared with base line. It was observed that Jawārish bisbāsā significantly reduced the liver enzymes, e.g. SGOT, SGPT, Alkaline Phosphatase in comparison to baseline values. It may be concluded that Jawārish bisbāsā showed hepatoprotective effect in this clinical study.

Effects of word-of-mouth versus traditional marketing: findings from an internet social networking site

The authors study the effect of word-of-mouth (WOM) marketing on member growth at an Internet social networking site and compare it with traditional marketing vehicles. Because social network sites record the electronic invitations from existing members, outbound WOM can be precisely tracked. Along with traditional marketing, WOM can then be linked to the number of new members subsequently joining the site (sign-ups). Because of the endogeneity among WOM, new sign-ups, and traditional marketing activity, the authors employ a vector autoregression (VAR) modeling approach. Estimates from the VAR model show that WOM referrals have substantially longer carryover effects than traditional marketing actions and produce substantially higher response elasticises. Based on revenue from advertising impressions served to a new member, the monetary value of a WOM referral can be calculated; this yields an upper-bound estimate for the financial incentives the firm might offer to stimulate WOM.pre-prin

Choice Models and Customer Relationship Management

Customer relationship management (CRM) typically involves tracking individual customer behavior over time, and using this knowledge to configure solutions precisely tailored to the customers' and vendors' needs. In the context of choice, this implies designing longitudinal models of choice over the breadth of the firm's products and using them prescriptively to increase the revenues from customers over their lifecycle. Several factors have recently contributed to the rise in the use of CRM in the marketplacePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47023/1/11002_2005_Article_5892.pd