Training Non-Specialists for Craniomaxillofacial Trauma in a Warzone Setting

This study investigated a simulated craniomaxillofacial (CMF) trauma training programme for non-specialist clinicians involved in warfare environments. Many clinicians lack CMF surgical training and the course was designed as a one-day research programme to establish if non-specialists could acquire CMF trauma skills adequate for a warzone. The course consisted of six simulation skills, of which four used sheep heads to teach craniotomy, epistaxis, canthotomy and cantholysis and external pin fixation for mandibular fracture fixation. In addition, two skills utilised plaster dental models designed to enable fixation of mandibular fractures with the Erich arch bar or dental eyelet wiring. This simulation-based programme taught trauma management without the expense of cadavers or risks to patients [1]. The trainees were scored for each of the six skills by hierarchical task analysis (HTA) designed by CMF specialists [2, 3]. The trainee assessment scores improved significantly in all skills post-training, regardless of their medical or surgical deficiencies demonstrating that non-specialists can learn important surgical techniques, valuable for war environments

Dopamine axons in dorsal striatum encode contralateral visual stimuli and choices.

The striatum plays critical roles in visually-guided decision making and receives dense axonal projections from midbrain dopamine neurons. However, the roles of striatal dopamine in visual decision making are poorly understood. We trained male and female mice to perform a visual decision task with asymmetric reward payoff, and we recorded the activity of dopamine axons innervating striatum. Dopamine axons in the dorsomedial striatum (DMS) responded to contralateral visual stimuli and contralateral rewarded actions. Neural responses to contralateral stimuli could not be explained by orienting behavior such as eye movements. Moreover, these contralateral stimulus responses persisted in sessions where the animals were instructed to not move to obtain reward, further indicating that these signals are stimulus-related. Lastly, we show that DMS dopamine signals were qualitatively different from dopamine signals in the ventral striatum, which responded to both ipsi- and contralateral stimuli, conforming to canonical prediction error signaling under sensory uncertainty. Thus, during visual decisions, DMS dopamine encodes visual stimuli and rewarded actions in a lateralized fashion, and could facilitate associations between specific visual stimuli and actions

Correction: Detecting antimicrobial resistance in Escherichia coli using benchtop attenuated total reflectance-Fourier transform infrared spectroscopy and machine learning.

Correction for 'Detecting antimicrobial resistance in Escherichia coli using benchtop attenuated total reflectance-Fourier transform infrared spectroscopy and machine learning' by Hewa G. S. Wijesinghe et al., Analyst, 2021, DOI: 10.1039/d1an00546d

Direct and indirect effects of rotavirus vaccination: Comparing predictions from transmission dynamic models

Early observations from countries that have introduced rotavirus vaccination suggest that there may be indirect protection for unvaccinated individuals, but it is unclear whether these benefits will extend to the long term. Transmission dynamic models have attempted to quantify the indirect protection that might be expected from rotavirus vaccination in developed countries, but results have varied. To better understand the magnitude and sources of variability in model projections, we undertook a comparative analysis of transmission dynamic models for rotavirus. We fit five models to reported rotavirus gastroenteritis (RVGE) data from England and Wales, and evaluated outcomes for short- and long-term vaccination effects. All of our models reproduced the important features of rotavirus epidemics in England and Wales. Models predicted that during the initial year after vaccine introduction, incidence of severe RVGE would be reduced 1.8-2.9 times more than expected from the direct effects of the vaccine alone (28-50% at 90% coverage), but over a 5-year period following vaccine introduction severe RVGE would be reduced only by 1.1-1.7 times more than expected from the direct effects (54-90% at 90% coverage). Projections for the long-term reduction of severe RVGE ranged from a 55% reduction at full coverage to elimination with at least 80% coverage. Our models predicted short-term reductions in the incidence of RVGE that exceeded estimates of the direct effects, consistent with observations from the United States and other countries. Some of the models predicted that the short-term indirect benefits may be offset by a partial shifting of the burden of RVGE to older unvaccinated individuals. Nonetheless, even when such a shift occurs, the overall reduction in severe RVGE is considerable. Discrepancies among model predictions reflect uncertainties about age variation in the risk and reporting of RVGE, and the duration of natural and vaccine-induced immunity, highlighting important questions for future research

A systematic review and meta-analysis of studies comparing burden from lung cancer and chronic obstructive pulmonary disease.

BACKGROUND:Chronic obstructive pulmonary disease and lung cancer are both life-limiting diseases that confer burden in the form of symptoms and affect functioning and quality of life. Comparing burden between these diseases is of interest to determine whether people with chronic obstructive pulmonary disease require improved access to Specialist Palliative Care. Access should be based on needs rather than diagnosis or prognosis but is limited for people with chronic obstructive pulmonary disease compared to lung cancer. AIM:The aim of this study was to synthesise research comparing burden from chronic obstructive pulmonary disease and lung cancer to estimate relative need for Specialist Palliative Care. DESIGN:A systematic review was conducted of observational quantitative studies published in English peer-reviewed journals comparing burden from chronic obstructive pulmonary disease and lung cancer (PROSPERO CRD42018108819). No limits were placed on disease stage. Meta-analyses were performed where studies used the same measure; otherwise, synthesis used a narrative approach. Risk of bias was assessed using the Agency for Healthcare Research and Quality tool. DATA SOURCES:Electronic databases were searched in September 2019. RESULTS:Of 790 articles returned, 13 were included, reporting 11 studies. Risk of bias was generally moderate. Except for pain, burden tended to be at least as substantial from chronic obstructive pulmonary disease as from lung cancer, with breathlessness and impacts on functioning being significantly worse. Longitudinal studies suggest that people with chronic obstructive pulmonary disease live with burden for longer. CONCLUSION:Efforts should be made to ensure that access to Specialist Palliative Care is commensurate with chronic obstructive pulmonary disease's substantial and long-lasting burden. Future research should clarify whether managing burden in chronic obstructive pulmonary disease and lung cancer requires different approaches

EVALUASI STRATEGI BERSAING HOTEL X BERDASARKAN ANALISIS THE FIVE MAJOR ELEMENTS OF STRATEGY STUDI KASUS

Dalam usahanya untuk bertahan dalam berbagai kondisi pasar, setiap perusahaan atau organisasi seharusnya berusaha proaktif dan melakukan pembenahan serta memformulasi strategi yang diharapkan dapat berfungsi secara optimal mencapai tujuan organisasi. Setiap organisasi akan mengidentifikasi dan mengeksploitasi sumber daya yang dimiliki serta kesempatan yang ada di pasar, disesuaikan dengan kebutuhan dan tujuan masing-masing organisasi. Hal tersebut berarti strategi yang berbeda akan dipilih oleh setiap organisasi yang berbeda pula. Setiap organisasi, dalam memilih strategi, akan menyesuaikan langkahlangkah yang diambil untuk mencapai tujuan dengan sumber daya yang dimiliki. Hotel X merupakan salah satu pemain dalam sektor perdagangan hotel dan restoran di daerah Juanda, Sidoarjo. Hotel X merupakan hotel yang berdiri sejak 1993, hingga saat ini sudah menjadi hotel bintang tiga. Dengan usia hotel yang sudah sekitar dua puluh tahun, Hotel X selama ini sudah berhasil menjaga eksistensinya bahkan mampu berkembang cukup pesat dengan menambahkan unit kamar dan investasi bangunan baru. Dengan kondisi saat ini berlebihnya jumlah kamar hotel yang ditawarkan oleh hotel-hotel pesaing merupakan tantangan tersendiri bagi Hotel X untuk mempertahankan eksistensi yang sudah cukup lama terjaga. Dewasa ini dampak dari perubahan kondisi lingkungan pasar mulai terasa oleh Hotel X, diantaranya pendapatan usaha yang diperoleh mulai menurun, meningkatnya biaya pemasaran, turnover karyawan yang meningkat, dan perubahan lainnya yang menuntut Hotel X untuk segera menyesuaikan diri. Pertumbuhan usaha hotel terlalu tinggi yang tidak sebanding dengan jumlah pertumbuhan wisatawan asing maupun lokal, merupakan tantangan tersendiri bagi para pengusaha hotel dalam berkompetisi mendapatkan pelanggan, begitu juga dengan Hotel X. Untuk dapat mencapai tujuannya Hotel X telah memiliki strategi perusahaan, namun yang menjadi pertanyaan adalah, apakah strategi yang dimiliki oleh Hotel X sudah dijalankan dengan baik dan sesuai untuk memenangkan persaiangan. Peneliti berinisiatif untuk melakukan penelitian melalui evaluasi strategi yang disesuaikan dengan kondisi internal dan eksternal Hotel X dengan menggunakan The Five Major Elements of Strategy. Sesuai dengan pendapat Hambrick dan Frederickson (2001), The Five Major Elements of Strategy, strategi yang dimiliki sebuah perusahaan sangat penting untuk memiliki elemen-elemen turunan yang terpadu atau saling berkaitan sehingga dalam menjalankan strategi tersebut, perusahaan dalam mewujudkan strategi yang telah dimiliki untuk mencapai tujuannya

The influence of an infection with Ascaris suum on the intestinal microbiota of the host

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Removal of ecotoxicity of 17α-ethinylestradiol using TAML/peroxide water treatment

17α -ethinylestradiol (EE2), a synthetic oestrogen in oral contraceptives, is one of many pharmaceuticals found in inland waterways worldwide as a result of human consumption and excretion into wastewater treatment systems. At low parts per trillion (ppt), EE2 induces feminisation of male fish, diminishing reproductive success and causing fish population collapse. Intended water quality standards for EE2 set a much needed global precedent. Ozone and activated carbon provide effective wastewater treatments, but their energy intensities and capital/operating costs are formidable barriers to adoption. Here we describe the technical and environmental performance of a fast- developing contender for mitigation of EE2 contamination of wastewater based upon smallmolecule, full-functional peroxidase enzyme replicas called “TAML activators”. From neutral to basic pH, TAML activators with H2O2 efficiently degrade EE2 in pure lab water, municipal effluents and EE2-spiked synthetic urine. TAML/H2O2 treatment curtails estrogenicity in vitro and substantially diminishes fish feminization in vivo. Our results provide a starting point for a future process in which tens of thousands of tonnes of wastewater could be treated per kilogram of catalyst. We suggest TAML/H2O2 is a worthy candidate for exploration as an environmentally compatible, versatile, method for removing EE2 and other pharmaceuticals from municipal wastewaters.Heinz Endowments, the Swiss National Science Foundation, the Steinbrenner Institute for a Steinbrenner Doctoral Fellowship. NMR instrumentation at CMU was partially supported by NSF (CHE-0130903 and CHE-1039870)

Promoter methylation regulates cyclooxygenase expression in breast cancer

INTRODUCTION: Overexpression of cyclooxygenase (COX-2) is commonly observed in human cancers. In a murine model of metastatic breast cancer, we observed that COX-2 expression and enzyme activity were associated with enhanced tumorigenic and metastatic potential. In contrast to the high COX-2 expression in metastatic tumors, transplantation of poorly tumorigenic tumor cell lines to syngeneic mice results in less COX-2 expression and less COX-2 activity in vivo. Aberrant CpG island methylation, and subsequent silencing of the COX-2 promoter, has been observed in human cancer cell lines and in some human tumors of the gastrointestinal tract. METHODS: Using bisulfite modification and a methylation-specific PCR, we examined the methylation status of the COX-2 promoter in a series of four closely-related murine mammary tumors differing in COX-2 expression and metastatic potential. RESULTS: We showed that line 410, which does not express COX-2 in vivo, exhibited evidence of promoter methylation. Interestingly, the metastatic counterpart of this cell (line 410.4) displayed only the unmethylated COX-2 promoter, as did two additional cell lines (lines 66.1 and 67). The methylation patterns observed in vitro were maintained when these murine mammary tumor lines were transplanted to syngeneic mice. Treatment with the DNA demethylating agent 5-aza-deoxycytidine increased COX-2 mRNA, increased protein and increased enzyme activity (prostaglandin synthesis). CONCLUSIONS: These results indicate that COX-2 promoter methylation may be one mechanism by which tumor cells regulate COX-2 expression. Upregulation of COX-2 expression in closely related metastatic lesions versus nonmetastatic lesions may represent a shift towards the unmethylated phenotype

Safeguarding children in dentistry: 1. Child protection training, experience and practice of dental professionals with an interest in paediatric dentistry

* Few dental professionals with child protection training have experience of making referrals. * There is a wide gap in practice between recognising signs of child abuse and neglect and responding effectively. * This may indicate missed opportunities to save children from continuing abuse. * There is a need for improved child protection information, support and training for dental professionals. Abstract Following several highly publicised inquiries into the deaths of children from abuse and neglect, there has been much recent interest in the role and responsibility of all health professionals to protect children at risk of maltreatment. The findings of a postal questionnaire, sent in March 2005 to 789 dentists and dental care professionals with an interest in paediatric dentistry working in varied settings in the UK, are presented in a two-part report and discussed in the context of current multi-agency good practice in safeguarding and promoting the welfare of children. This first part explores reported child protection training, experience and practice. There was a significant gap between recognising signs of abuse and responding effectively: 67% of respondents had suspected abuse or neglect of a child patient at some time in their career but only 29% had ever made a child protection referral. The dental profession is alerted to the need to ensure necessary appropriate action to safeguard children is always taken when child abuse or neglect are suspected