In situ anticaries efficacy of dentifrices with different formulations – A pooled analysis of results from three randomized clinical trials

Objectives Data generated from three similar in situ caries crossover studies presented the opportunity to conduct a pooled analysis to investigate how dentifrice formulations with different fluoride salts and combinations at concentrations of 1400–1450 ppm F, different abrasive systems and in some cases, carbomer (Carb), affect enamel caries lesion remineralization and fluoridation. Methods Subjects continuously wore modified partial dentures holding two gauze-covered partially-demineralized human enamel specimens for 14 days and brushed 2×/day with their assigned dentifrice: Study 1: sodium fluoride (NaF)/Carb/silica, NaF/silica, NaF + monofluorophosphate (MFP)/chalk; Study 2: NaF/Carb/silica, NaF + MFP/dical, amine fluoride (AmF)/silica; Study 3: NaF/Carb/silica, NaF + stannous fluoride (SnF2)/silica/hexametaphosphate (HMP). All studies included Placebo (0 ppm F) and/or dose-response controls (675 ppm F as NaF [675F-NaF]) ±Carb. Specimens were evaluated for percentage surface microhardness recovery (SMHR) and enamel fluoride uptake (EFU). Results All 1400–1450 ppm F dentifrices except NaF + SnF2/silica/HMP provided significantly greater lesion remineralization than Placebo (p < 0.0001): differences in SMHR ranged from 17.46% (NaF + MFP/dical) to 26.66% (AmF/silica). For EFU (back-transformed log EFU), all 1400–1450 ppm F dentifrices gave significant fluoride uptake compared to Placebo (p < 0.0001): increases in EFU ranged from 4.95 μg F/cm2 (NaF + SnF2/silica/HMP) to 16.32 μg F/cm2 (NaF/carb/silica). Dentifrices containing NaF or AmF as sole fluoride source provided the greatest remineralization and fluoridation; Carb addition did not alter fluoride efficacy; some excipients appeared to interfere with the cariostatic action of fluoride. Treatments were generally well-tolerated with ≤4 treatment-related adverse events per study. Conclusion Commercially available fluoride dentifrices varied greatly in their ability to remineralize and fluoridate early caries lesions. Clinical significance Fluoride dentifrices are the most impactful anticaries modality worldwide. While clinical caries trials have not consistently shown the superiority of one formulation over another, these findings using a sensitive in situ caries model indicated that dentifrices containing NaF or AmF as the sole fluoride source provided the greatest remineralization and fluoridation benefits

Concepts émergents dans le référentiel de compétences CanMEDS pour les médecins

Background: The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies. Methods: Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted. Results: 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts. Conclusion: This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.Contexte : Le référentiel de compétences CanMEDS pour les médecins sera mis à jour en 2025. Cette révision intervient à un moment où la société, les soins de santé et l’enseignement médical sont bouleversés et en pleine mutation à cause de la pandémie de la COVID-19; on est aussi à l’heure où l’on reconnaît de plus en plus les effets du colonialisme, de la discrimination systémique, des changements climatiques et des nouvelles technologies sur les soins de santé et la formation des médecins. Pour éclairer cette révision, nous avons tenté d’extraire de la littérature scientifique les concepts émergents se rapportant aux compétences des médecins. Méthodes : Les concepts émergents ont été définis comme des idées ayant trait aux rôles et aux compétences des médecins qui sont débattues dans la littérature, mais qui sont absentes ou sous-représentées dans le cadre CanMEDS 2015. Nous avons réalisé une recherche documentaire, un examen des titres et des résumés, et une analyse thématique pour repérer les concepts émergents. Les métadonnées de tous les articles publiés dans cinq revues d’éducation médicale entre le 1er octobre 2018 et le 1er octobre 2021 ont été extraites. Quinze auteurs ont effectué un examen des titres et des résumés pour relever et étiqueter les concepts sous-représentés. Deux auteurs ont procédé à une analyse thématique des résultats pour dégager les concepts émergents. Une vérification a été faite par les membres de l’équipe. Résultats : Parmi les 4973 articles dépouillés, 1017 (20,5 %) abordaient un concept émergent. Les dix thèmes suivants sont ressortis de l’analyse thématique : l’équité, la diversité, l’inclusion et la justice sociale; l’antiracisme; humanisme des médecin; la médecine fondée sur les données; les systèmes adaptatifs complexes; l’environnement de l’apprentissage clinique; les soins virtuels; le raisonnement clinique; l’expertise adaptative; et la santé planétaire. L’ensemble de ces thèmes ont été approuvés comme concepts émergents par l’équipe de rédaction. Conclusion : Cet examen de la littérature a permis de relever dix concepts émergents qui peuvent servir à éclairer la révision du référentiel de compétences CanMEDS pour les médecins qui aura lieu en 2025. La publication en libre accès de ce travail favorisera la transparence du processus de révision et le dialogue continu sur les compétences des médecins. Des groupes de rédaction ont été recrutés pour développer chacun des concepts émergents et pour examiner la façon dont ils pourraient être intégrés dans la version du référentiel CanMEDS de 2025

Children\u27s Sleep during COVID-19: How Sleep Influences Surviving and Thriving in Families

Objective The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents and children s needs to support sleep during the pandemic. Methods Eighty-five Canadian parents with children aged 4 14 years participated in this explanatory sequential, mixed-methods study using an online survey of children s and parents sleep, with a subset of 16 parents, selected based on changes in their children s sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. Results While some parents perceived their child s sleep quality improved during the COVID-19 pandemic (14.1%, n 12), many parents perceived their child s sleep had worsened (40.0%, n 34). Parents attributed children s worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children s and parents sleep. Conclusions The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children s sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges

Analysis of a General Family of Regularized Navier-Stokes and MHD Models

We consider a general family of regularized Navier-Stokes and Magnetohydrodynamics (MHD) models on n-dimensional smooth compact Riemannian manifolds with or without boundary, with n greater than or equal to 2. This family captures most of the specific regularized models that have been proposed and analyzed in the literature, including the Navier-Stokes equations, the Navier-Stokes-alpha model, the Leray-alpha model, the Modified Leray-alpha model, the Simplified Bardina model, the Navier-Stokes-Voight model, the Navier-Stokes-alpha-like models, and certain MHD models, in addition to representing a larger 3-parameter family of models not previously analyzed. We give a unified analysis of the entire three-parameter family using only abstract mapping properties of the principle dissipation and smoothing operators, and then use specific parameterizations to obtain the sharpest results. We first establish existence and regularity results, and under appropriate assumptions show uniqueness and stability. We then establish results for singular perturbations, including the inviscid and alpha limits. Next we show existence of a global attractor for the general model, and give estimates for its dimension. We finish by establishing some results on determining operators for subfamilies of dissipative and non-dissipative models. In addition to establishing a number of results for all models in this general family, the framework recovers most of the previous results on existence, regularity, uniqueness, stability, attractor existence and dimension, and determining operators for well-known members of this family.Comment: 37 pages; references added, minor typos corrected, minor changes to revise for publicatio

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Evaluation of measures used for diagnosis of obstructive sleep apnea in children

BACKGROUND: In children, sleep-related airway obstruction by large tonsils and adenoids can cause obstructive sleep apnea (OSA). OSA may lead to poor growth, developmental delay, behaviour or learning problems. Recent evidence also suggests that children with OSA may develop cardiovascular complications, the mechanisms perhaps involving hypoxemia, the autonomic nervous system, apneas, and arousals. Surgical removal of tonsils and adenoids (adenotonsillectomy (T&A)) usually cures pediatric OSA. To diagnose OSA at all levels of severity, polysomnography is currently the best approach. The McGill Oximetry Score (MOS) is a validated measure based on nocturnal pulse oximetry. An abnormal MOS has a 97% positive predictive value at detecting moderate-severe OSA. Because the MOS was devised by measuring frequency of desaturations (&lt;90%) and numbers of clusters of desaturations, it is not accurate at detecting OSA in children who do not have such drops in oxygen saturation. Accordingly, other measures applicable to a wider spectrum of children should be assessed. These measures should be simpler, less cumbersome, cheaper, and more accessible than polysomnography.OBJECTIVES: To study alternative approaches that may be used to identify moderate-severe OSA in children, two studies were conducted. We examined one subjective measure - the OSA-18 parent questionnaire - and two objective measures - pulse rate and pulse rate variability. For the OSA-18 study, the goal was to determine whether it would accurately detect children with moderate-severe OSA as indicated by an abnormal MOS. For the pulse rate and pulse rate variability study, the goal was to determine if either or both would decrease after treatment with T&A for children with moderate-severe OSA.METHODS: For the OSA-18 study, we used a cross-sectional design that included children 1-18 years old referred to a pediatric sleep laboratory for evaluation of suspected OSA. Alongside data from the OSA-18, we analyzed demographic and medical data (from a parent questionnaire) and information regarding adenotonsillar hypertrophy. We estimated sensitivity, specificity, positive and negative predictive values as well as receiver operating curves of the OSA-18 in detecting an abnormal MOS. We also conducted univariate and multivariate logistic regression analyses, using the MOS as the dependent variable and the OSA-18 score and others (age, gender, comorbidities, race) as independent variables. For the second study, we used a retrospective before-after design to compare pulse rate and pulse rate variability as measured by nocturnal pulse oximetry pre- and post-T&A of otherwise healthy children 1-18 years old with moderate-to-severe OSA.RESULTS: For the OSA-18 study, we studied 334 children (58% male, mean age 4.6 +/- 2.2 years). The OSA-18 had a sensitivity of 40% and a negative predictive value of 73% for detecting an abnormal MOS. In addition, the area under the receiver operating curve was 0.611. While controlling for other independent variables in the logistic regression model, for each unit increase in the OSA-18 Score, the odds of having an abnormal MOS were increased by 2%. However, for each increase in age of 1 year, the odds of having an abnormal MOS were decreased by 17%. In the pulse rate and pulse rate variability study, 25 subjects (88% male; mean age 4.3 +/- 3.6 years) were enrolled. Following T&A, pulse rate and pulse rate variability decreased in 21 of 25 and 23 of 25 children, respectively. Mean pulse rate dropped from 99.7+/-11.2 to 90.1+/-10.7 bpm, p&lt;0.001; age-standardized pulse rate (z-score) from 0.8 (0.4, 1.5) to 0.4 (0, 0.9), p=0.04). Pulse rate variability, as measured by the standard deviation of the pulse rate decreased from 10.3 +/- 2.1 to 8.2 +/- 1.6 bpm, p&lt;0.001. As well, OSA symptomatology, parental concern about breathing during sleep and the MOS all improved.CONCLUSIONS: Based on the first study we conclude that among children referred to a sleep laboratory, the OSA-18 does not accurately detect which children will have an abnormal MOS. The OSA-18 should not be used in place of objective testing to identify moderate-severe OSA in children. However, from the second study we conclude that measures of the autonomic nervous system such as pulse rate and pulse rate variability, as measured by pulse oximetry, decreased following surgical treatment of moderate-severe OSA. The results of this study potentially serve as important data for further work that would determine the accuracy of pulse rate and pulse rate variability measures and their diagnostic usefulness for OSA at all levels of severity