The Exponential Rise of Teledentistry and Patient-Oriented Protective Measures in Southeast Asian Dental Clinics: Concerns, Benefits, and Challenges

In the Southeast Asian region, various policies have been advocated by health regulatory bodies that entail protective measures such as face masks, gloves, maintaining distance in public areas, and more. These protective measures are aimed at helping reverse the growth rate of the coronavirus. Dentists in this region have incorporated several changes to their practices to help minimize risks of person-to-person transmission inside dental offices. This narrative review aimed to provide an in-depth overview of the current situation in the Southeast Asian region regarding the use of teledentistry during the pandemic. Teledentistry involves the transfer of patient information across remote distances for online consultation and treatment planning. A few years back, it used to be a lesser-known entity but has seen an exponential rise in its incorporation into dental practices all around the Association of Southeast Nations (ASEAN) region. Many clinics in the Southeast Asian region have started using online consultations to ensure that patients can be diagnosed or followed up during their treatment. Teledentistry is the clear answer in the coming months as it will help reduce the risk of virus transmission and help patients get access to oral healthcare and dentists to see their patients. This article reviews the current pandemic situation in the ASEAN region, the recent evidence, and the scope of teledentistry. It also provides recommendations for the future and sheds light on the different types of teledentistry and how it can be incorporated into practices by regulatory authorities in this region

Dentinal microcracks after root canal instrumentation using instruments manufactured with different NiTi alloys and the SAF system: A systematic review

Aim: The aim of this systematic analysis was to assess the prevalence of dentinal microcracks at various levels (3, 6, and 9mm from the apex) after using instruments made with conventional, R-Phase, and M-Wire NiTi alloys and the SAF system. Materials and Methods: Electronic searches were conducted in the databases Embase, Cochrane Library, Scopus, PubMed, andWeb of Science. To arrange search methods, “MeSH” terms and/or keywords typically associated with the subject were paired with the Boolean operators “AND” and “OR.” Additional searches were conducted on the websites of four separate endodontic journals. After reading the titles and excluding duplicates, 1000 of the 1343 documents originally found were eliminated. Upon reviewing the abstracts, 310 of the remaining 343 experiments were also eliminated. Based on qualifying requirements, only 13 of the remaining 33 articles were included in the qualitative review. Results: All systems triggered dentinal microcracks; however, when chemo-mechanical preparation was performed using Self-Adjusting File (SAF) and systems manufactured with R-phase technology—K3XF and Twisted File Adaptive (TFA)—less of these defects were found when compared to those manufactured with traditional NiTi—ProTaper Universal and Mtwo—and with M-Wire—ProTaper Next, Reciproc, and WaveOne. Conclusions: A lower prevalence of dentinal microcracks was observed after using SAF and endodontic systems manufactured with R-phase

Coherence properties of an atom laser

We study the coherence properties of an atom laser, which operates by extracting atoms from a gaseous Bose-Einstein condensate via a two-photon Raman process, by analyzing a recent experiment. We obtain good agreement with the experimental data by solving the time-dependent Gross-Pitaevskii equation in three dimensions both numerically and with a Thomas-Fermi model. The coherence length is strongly affected by the space-dependent phase developed by the condensate when the trapping potential is turned off.Comment: 11 pages, 2 Postscript figure

Increased condom use among key populations using oral PrEP in Kenya: results from large scale programmatic surveillance

Background: Female sex workers (FSW) and men having sex with men (MSM) in Kenya have high rates of HIV infection. Following a 2015 WHO recommendation, Kenya initiated national scale-up of pre-exposure prophylaxis (PrEP) for all persons at high-risk. Concerns have been raised about PrEP users’ potential changes in sexual behaviors such adopting condomless sex and multiple partners as a result of perceived reduction in HIV risk, a phenomenon known as risk compensation. Increased condomless sex may lead to unintended pregnancies and sexually transmitted infections and has been described in research contexts but not in the programmatic setting. This study looks at changes in condom use among FSW and MSM on PrEP through a national a scale-up program. Methods: Routine program data collected between February 2017 and December 2019 were used to assess changes in condom use during the frst three months of PrEP in 80 health facilities supported by a scale-up project, Jilinde. The primary outcome was self-reported condom use. Analyses were conducted separately for FSW and for MSM. Log-Binomial Regression with Generalized Estimating Equations was used to compare the incidence proportion (“risk”) of consistent condom use at the month 1, and month 3 visits relative to the initiation visit. Results: At initiation, 69% of FSW and 65% of MSM reported consistent condom use. At month 3, this rose to 87% for FSW and 91% for MSM. MSM were 24% more likely to report consistent condom use at month 1 (Relative Risk [RR], 1.24, 95% Confidence Interval [CI], 1.18–1.30) and 40% more likely at month 3 (RR, 1.40, 95% CI, 1.33–1.47) compared to at initiation. FSW were 15% more likely to report consistent condom use at the month one visit (RR, 1.15, 95% CI, 1.13–1.17) and 27% more likely to report condom use on the month 3 visit (RR 1.27, 95% CI, 1.24–1.29). Conclusion: Condom use increased substantially among both FSW and MSM. This may be because oral PrEP was provided as part of a combination prevention strategy that included counseling and condoms but could also be due to the low retention rates among those who initiated

Impacts of rain forest fragmentation on butterflies in northern Borneo: species richness, turnover and the value of small fragments

• 1. Widespread and rapid losses of tropical rain forests have made understanding the responses of species to rain forest fragmentation an area of major concern. In this study we examined the impacts of habitat fragmentation on the species richness and faunal composition of butterflies in tropical rain forests in Sabah, Borneo. We analysed patterns of both α‐ and β‐diversity to assess the relative importance of differences in patch size, isolation and vegetation structure on the diversity and similarity of species assemblages. We used additive partitioning to assess the relative contributions of intact forest and forest remnants to overall species richness at a landscape scale and we examined which traits of species best predicted their responses to fragmentation. • 2. Species richness and diversity in rain forest remnants was significantly positively related to remnant size and significantly negatively related to isolation, in keeping with theories of island biogeography. Species assemblages at different sites were significantly nested, with those species most adversely affected by forest fragmentation having a narrow range of larval host‐plants and, to a lesser extent, being large‐bodied. No species endemic to Borneo was recorded in forest remnants smaller than 4000 ha, but even the smallest remnant (120 ha) supported species with geographical distributions confined within Sundaland (West Malaysia and the islands of the Sunda Shelf). • 3. Although assemblages were significantly nested, they departed substantially from perfect nestedness, with some species recorded only or predominantly in small, relatively depauperate remnants. As a result there was substantial β‐diversity among sites, which was related to variation in both fragment size and vegetation structure. At the landscape scale, diversity within sites was less than that between sites, and the majority of the diversity between sites was related to variation in fragment size. • 4. Synthesis and applications. Substantial diversity was added to the assemblage of butterflies in Bornean rain forests by virtue of species differences among fragments, which were related mainly to differences in patch size and vegetation structure. The data reported indicate that, despite having lower species richness, relatively small and isolated remnants of rain forest make a substantial contribution to regional diversity. Small isolated forest remnants are generally accorded low conservation status and given little protection, with the result that they often disappear over time because of continued anthropogenic disturbance. The results of this study indicate that the conservation value of small remnants of forest, in particular their contribution to environmental heterogeneity, should not be overlooked

Coherence Properties of an Atom Laser

We study the coherence properties of an atom laser, which operates by extracting atoms from a gaseous Bose-Einstein condensate via a two-photon Raman process, by analysing a recent experiment (Hagley et al1999 Phys. Rev. Lett.833112). We obtain good agreement with the experimental data by solving the time-dependent Gross-Pitaevskii equation in three dimensions both numerically and with a Thomas-Fermi model. The coherence is strongly affected by the space-dependent phase developed by the condensate when the trapping potential is turned off

Effect of substituting IPV for tOPV on immunity to poliovirus in Bangladeshi infants: An open-label randomized controlled trial

AbstractBackgroundThe Polio Endgame strategy includes phased withdrawal of oral poliovirus vaccines (OPV) coordinated with introduction of inactivated poliovirus vaccine (IPV) to ensure population immunity. The impact of IPV introduction into a primary OPV series of immunizations in a developing country is uncertain.MethodsBetween May 2011 and November 2012, we enrolled 700 Bangladeshi infant-mother dyads from Dhaka slums into an open-label randomized controlled trial to test whether substituting an injected IPV dose for the standard Expanded Program on Immunization (EPI) fourth tOPV dose at infant age 39 weeks would reduce fecal shedding and enhance systemic immunity. The primary endpoint was mucosal immunity to poliovirus at age one year, measured by fecal excretion of any Sabin virus at five time points up to 25 days post-52 week tOPV challenge, analyzed by the intention to treat principle.FindingsWe randomized 350 families to the tOPV and IPV vaccination arms. Neither study arm resulted in superior intestinal protection at 52 weeks measured by the prevalence of infants shedding any of three poliovirus serotypes, but the IPV dose induced significantly higher seroprevalence and seroconversion rates. This result was identical for poliovirus detection by cell culture or RT-qPCR. The non-significant estimated culture-based shedding risk difference was −3% favoring IPV, and the two vaccination schedules were inferred to be equivalent within a 95% confidence margin of −10% to +4%. Results for shedding analyses stratified by poliovirus type were similar.ConclusionsNeither of the vaccination regimens is superior to the other in enhancing intestinal immunity as measured by poliovirus shedding at 52 weeks of age and the IPV regimen provides similar intestinal immunity to the four tOPV series, although the IPV regimen strongly enhances humoral immunity. The IPV-modified regimen may be considered for vaccination programs without loss of intestinal protection

The origin of fracture in the I-ECAP of AZ31B magnesium alloy

Magnesium alloys are very promising materials for weight-saving structural applications due to their low density, comparing to other metals and alloys currently used. However, they usually suffer from a limited formability at room temperature and low strength. In order to overcome those issues, processes of severe plastic deformation (SPD) can be utilized to improve mechanical properties, but processing parameters need to be selected with care to avoid fracture, very often observed for those alloys during forming. In the current work, the AZ31B magnesium alloy was subjected to SPD by incremental equal-channel angular pressing (I-ECAP) at temperatures varying from 398 K to 525 K (125 °C to 250 °C) to determine the window of allowable processing parameters. The effects of initial grain size and billet rotation scheme on the occurrence of fracture during I-ECAP were investigated. The initial grain size ranged from 1.5 to 40 µm and the I-ECAP routes tested were A, BC, and C. Microstructures of the processed billets were characterized before and after I-ECAP. It was found that a fine-grained and homogenous microstructure was required to avoid fracture at low temperatures. Strain localization arising from a stress relaxation within recrystallized regions, namely twins and fine-grained zones, was shown to be responsible for the generation of microcracks. Based on the I-ECAP experiments and available literature data for ECAP, a power law between the initial grain size and processing conditions, described by a Zener–Hollomon parameter, has been proposed. Finally, processing by various routes at 473 K (200 °C) revealed that route A was less prone to fracture than routes BC and C

Hyponatremia and hospital outcomes among patients with pneumonia: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Community-acquired (CAP) and nosocomial pneumonias contribute substantially to morbidity and hospital resource utilization. Hyponatremia, occurring in >1/4 of patients with CAP, is associated with greater disease severity and worsened outcomes.</p> <p>Methods</p> <p>To explore how hyponatremia is associated with outcomes in hospitalized patients with pneumonia, we analyzed a large administrative database with laboratory component from January 2004 to December 2005. Hyponatremia was defined as at least two [Na⁺] < 135 mEq/L within 24 hours of admission value.</p> <p>Results</p> <p>Of 7,965 patients with pneumonia, 649 (8.1%) with hyponatremia were older (72.4 ± 15.7 vs. 68.0 ± 22.0, p < 0.01), had a higher mean Deyo-Charlson Comorbidity Index Score (1.7 ± 1.7 vs. 1.6 ± 1.6, p = 0.02), and higher rates of ICU (10.0% vs. 6.3%, p < 0.001) and MV (3.9% vs. 2.3%, p = 0.01) in the first 48 hours of hospitalization than patients with normal sodium. Hyponatremia was associated with an increased ICU (6.3 ± 5.6 vs. 5.3 ± 5.1 days, p = 0.07) and hospital lengths of stay (LOS, 7.6 ± 5.3 vs. 7.0 ± 5.2 days, p < 0.001) and a trend toward increased hospital mortality (5.4% vs. 4.0%, p = 0.1). After adjusting for confounders, hyponatremia was associated with an increased risk of ICU (OR 1.58, 95% CI 1.20–2.08), MV (OR 1.75 95% CI 1.13–2.69), and hospital death (OR 1.3, 95% CI 0.90–1.87) and with increases of 0.8 day to ICU and 0.3 day to hospital LOS, and over $1,300 to total hospital costs.</p> <p>Conclusion</p> <p>Hyponatremia is common among hospitalized patients with pneumonia and is associated with worsened clinical and economic outcomes. Studies in this large population are needed to explore whether prompt correction of [Na⁺] may impact these outcomes.</p