Evaluation of heart attack admissions pre- and post-implementation of a smoke-free indoor air policy [abstract]

Multiple laboratory and epidemiological studies find secondhand smoke exposure causes adverse health outcomes. Additionally, an increasing number of studies at community, state and national levels identify significant reductions in hospital admission rate of acute myocardial infarction (AMI) after implementation of a smoke-free indoor air law. A more complete understanding of the health and other benefits related to implementation of community-wide smoke-free ordinances will increase evidence to support policy change in additional communities. Purpose: This project examines changes in hospital admissions for AMI before and after implementation of the comprehensive indoor air ordinance in Columbia, MO. Method: The Hospital Industry Data Institute (HIDI) and Harry S. Truman Memorial Veterans' Hospital provided incidence data for AMI admissions in Columbia, surrounding areas and a regional comparison city without a comprehensive smoke-free indoor air ordinance (Jefferson City, MO) for three years before and two years after implementation of Columbia's smoke-free policy. Poisson analyses tested differences in population-adjusted AMI rates before and after implementation in each population. Results: Implementation of a smoke-free ordinance in Columbia was associated with a 25% reduction in the rate of acute myocardial infarction (p<0.05), compared to an 18% decrease in areas surrounding Columbia (p<0.05) and a non-significant 11% decline in Jefferson City. Conclusion: Implementation of a smoke-free ordinance in Columbia, MO is associated with a significant reduction in hospital admissions for AMI among those residing in city limits and surrounding areas

Applied mechanics of the Puricelli osteotomy: a linear elastic analysis with the finite element method

<p>Abstract</p> <p>Background</p> <p>Surgical orthopedic treatment of the mandible depends on the development of techniques resulting in adequate healing processes. In a new technical and conceptual alternative recently introduced by Puricelli, osteotomy is performed in a more distal region, next to the mental foramen. The method results in an increased area of bone contact, resulting in larger sliding rates among bone segments. This work aimed to investigate the mechanical stability of the Puricelli osteotomy design.</p> <p>Methods</p> <p>Laboratory tests complied with an Applied Mechanics protocol, in which results from the Control group (without osteotomy) were compared with those from Test I (Obwegeser-Dal Pont osteotomy) and Test II (Puricelli osteotomy) groups. Mandible edentulous prototypes were scanned using computerized tomography, and digitalized images were used to build voxel-based finite element models. A new code was developed for solving the voxel-based finite elements equations, using a reconditioned conjugate gradients iterative solver. The Magnitude of Displacement and von Mises equivalent stress fields were compared among the three groups.</p> <p>Results</p> <p>In Test Group I, maximum stress was seen in the region of the rigid internal fixation plate, with value greater than those of Test II and Control groups. In Test Group II, maximum stress was in the same region as in Control group, but was lower. The results of this comparative study using the Finite Element Analysis suggest that Puricelli osteotomy presents better mechanical stability than the original Obwegeser-Dal Pont technique. The increased area of the proximal segment and consequent decrease of the size of lever arm applied to the mandible in the modified technique yielded lower stress values, and consequently greater stability of the bone segments.</p> <p>Conclusion</p> <p>This work showed that Puricelli osteotomy of the mandible results in greater mechanical stability when compared to the original technique introduced by Obwegeser-Dal Pont. The increased area of the proximal segment and consequent decrease of the size of lever arm applied to the mandible in the modified technique yield lower stress values and displacements, and consequently greater stability of the bone segments.</p

Characterization of bone repair in rat femur after treatment with calcium phosphate cement and autogenous bone graft

<p>Abstract</p> <p>Background</p> <p>In this study, the biocompatibility, stability and osteotransductivity of a new cement based on alpha-tricalcium phosphate (alpha-TCP) were investigated in a bone repair model using a rat model.</p> <p>Methods</p> <p>The potential of alpha-TCP on bone repair was compared to autogenous bone grafting, and unfilled cavities were used as negative control. Surgical cavities were prepared and designated as test (T), implanted with alpha-TCP blocks; negative control (C - ), unfilled; and positive control (C + ), implanted with autogenous bone graft. Results were analyzed on postoperative days three, seven, 14, 21 and 60.</p> <p>Results</p> <p>The histological analyses showed the following results. Postoperative day three: presence of inflammatory infiltrate, erythrocytes and proliferating fibroblasts in T, C - and C + samples. Day seven: extensive bone neoformation in groups T and C + , and beginning of alpha-TCP resorption by phagocytic cells. Days 14 and 21: osteoblastic activity in the three types of cavities. Day 60: In all samples, neoformed bone similar to surrounding bone. Moderate interruption on the ostectomized cortical bone.</p> <p>Conclusions</p> <p>Bone neoformation is seen seven days after implantation of alpha-TCP and autogenous bone. Comparison of C - with T and C + samples showed that repair is faster in implanted cavities; on day 60, control groups presented almost complete bone repair. Alpha-TCP cement presents biocompatibility and osteotransductivity, besides stability, but 60 days after surgery the cavities were not closed.</p

Detection of PrPres in the spleen of hamsters used as an in vivo model for experimental TSE

In order to detect the presence of PrPres in the spleen of infected hamsters, we used a newly developed extraction method, before Western blot analysis, allowing the precipitation of PrPres. The NaPTA treatment applied before proteolysis causes a change in the PK cleavage site, resulting in the generation of larger PrPres fragments, acting on the N-terminal region of PrPres. By using this procedure, with some modifications, we succeeded in detecting the prion protein in the spleen and obtained the expected bands of prion protein, while in previous reports only very weak signals were obtained. Moreover, it was possible to confirm that the amount of detectable PrPres in the hamster spleen is very low, suggesting that the spleen plays a non-essential role for development of the disease in the hamster experimental model

Evaluating the usability of an interactive, bi-lingual, touchscreen-enabled breastfeeding educational programme: application of Nielson’s heuristics

Background: Usability challenges have to be met in an interactive computer program development and should meet all users’ needs. Objective: The study purpose was to conduct heuristic evaluation of an interactive, bilingual touch screen enabled breastfeeding educational program for Hispanic women living in rural settings.Methods: Two usability experts used Nielsen’s heuristics while reviewing the user interface in May 2013 using principles of Nielson’s Heuristics. Nielson’s heuristics are a set of usability engineering principles developed to identify issues in user interface design and involves analysis of the interface. The heuristic evaluations were carried out in the interface, program sections, and interactive educational modules. A total of 271 screens were evaluated and included: interface (n=5), program sections (n=223) and educational content (n=43).Results: A total of 97 violations were identified and were mostly related to interface (8violations/5screens) and program components (89violations/266screens). The most common violations reported were recognition rather than recall (62%, n=60), consistency and standards (14%, n=14), and match between the system and real world (9%, n= 9). Majority of the violations had minor usability issues (73%, n=71). The only catastrophic violation reported was due to the visibility of system status in the assessment modules.Conclusion: The results demonstrated that the system was more consistent with Nielsen’s usability heuristics.

A new technique for mandibular osteotomy

Sagittal split osteotomy (SSO) is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. However, the traditional design of buccal osteotomy, located at the junction of mandibular ramus and body, may prevent more extensive sliding between the bone segments, particularly on the advance, laterality and verticality of the mandibular body. The author proposes a new technical and conceptual solution, in which osteotomy is performed in a more distal region, next to the mental formamen. Technically, the area of contact between medullary-cancellous bone surfaces is increased, resulting in larger sliding rates among bone segments; it also facilitates the use of rigid fixation systems, with miniplates and monocortical screws. Conceptually, it interferes with the resistance arm of the mandible, seen as an interpotent lever of the third gender

Decreased VLDL-Apo B 100 fractional synthesis rate despite hypertriglyceridemia in subjects with type 2 diabetes and nephropathy

Subjects with Type 2 Diabetes Mellitus (T2DM) and diabetic nephropathy (DN) often exhibit hypertriglyceridemia. The mechanism(s) of such an increase are poorly known. OBJECTIVE: We investigated VLDL-Apo B 100 kinetics in T2DM subjects with and without DN, and in healthy controls. DESIGN: Stable isotope 13C-leucine infusion, and modelling analysis of tracer-to-tracee ratio dynamics in the protein product pool in the 6-8 hr period following tracer infusion, were employed. SETTING: Male subjects affected by T2DM, either with (n=9) or without (n=5) DN, and healthy male controls (n=6), were studied under spontaneous glycemic levels in the post-absorptive state. RESULTS: In the T2DM patients with DN, plasma triglyceride (TG) (2.2\ub10.8 mmol/L, Mean\ub1SD) and VLDL-Apo B 100 (17.4\ub110.4 mg/dl) concentrations, and VLDL-Apo B 100 pool (0.56\ub10.29 g), were 3e60-80% greater (p<0.05 or less) than those of the T2DM subjects without DN (TG: 1.4\ub10.5 mmol/L; VLDL-Apo B 100: 9.9\ub12.5 mg/dl; VLDL-Apo B 100 pool: 0.36\ub10.09 g), and 3e80-110% greater (p<0.04 or less) than those of nondiabetic controls (TG: 1.2\ub10.4 mmol/L; VLDL-Apo B 100: 8.2\ub11.7 mg/dl; VLDL-Apo B 100: 0.32\ub10.09 g). In sharp contrast however, in the subjects with T2DM and DN, VLDL-Apo B 100 FSR was 6550% lower (4.8\ub12.2 pools/day) than that of either the T2DM subjects without DN (9.9\ub14.3 pools/day, p<0.025) or the control subjects (12.5\ub19.1 pools/day, p<0.04). CONCLUSIONS: The hypertriglyceridemia of T2DM patients with DN is not due to hepatic VLDL-Apo B 100 overproduction, which is decreased, but it should be attributed to decreased apolipoprotein removal

Interruption of cancer screening services due to COVID-19 pandemic: lessons from previous disasters

Purpose: To review the scientific literature seeking lessons for the COVID-19 era that could be learned from previous health services interruptions that affected the delivery of cancer screening services. Methods: A systematic search was conducted up to April 17, 2020, with no restrictions on language or dates and resulted in 385 articles. Two researchers independently assessed the list and discussed any disagreements. Once a consensus was achieved for each paper, those selected were included in the review. Results: Eleven articles were included. Three studies were based in Japan, two in the United States, one in South Korea, one in Denmark, and the remaining four offered a global perspective on interruptions in health services due to natural or human-caused disasters. No articles covered an interruption due to a pandemic. The main themes identified in the reviewed studies were coordination, communication, resource availability and patient follow-up. Conclusion: Lessons learned applied to the context of COVID-19 are that coordination involving partners across the health sector is essential to optimize resources and resume services, making them more resilient while preparing for future interruptions. Communication with the general population about how COVID-19 has affected cancer screening, measures taken to mitigate it and safely re-establish screening services is recommended. Use of mobile health systems to reach patients who are not accessing services and the application of resource-stratified guidelines are important considerations. More research is needed to explore best strategies for suspending, resuming and sustaining cancer screening programs, and preparedness for future disruptions, adapted to diverse health care systems