Communication interventions to promote the public's awareness of antibiotics: a systematic review.

BackgroundInappropriate antibiotic use is implicated in antibiotic resistance and resultant morbidity and mortality. Overuse is particularly prevalent for outpatient respiratory infections, and perceived patient expectations likely contribute. Thus, various educational programs have been implemented to educate the public.MethodsWe systematically identified public-directed interventions to promote antibiotic awareness in the United States. PubMed, Google Scholar, Embase, CINAHL, and Scopus were queried for articles published from January 1996 through January 2016. Two investigators independently assessed titles and abstracts of retrieved articles for subsequent full-text review. References of selected articles and three review articles were likewise screened for inclusion. Identified educational interventions were coded for target audience, content, distribution site, communication method, and major outcomes.ResultsOur search yielded 1,106 articles; 34 met inclusion criteria. Due to overlap in interventions studied, 29 distinct educational interventions were identified. Messages were primarily delivered in outpatient clinics (N = 24, 83%) and community sites (N = 12, 41%). The majority included clinician education. Antibiotic prescription rates were assessed for 22 interventions (76%). Patient knowledge, attitudes, and beliefs (KAB) were assessed for 10 interventions (34%). Similar rates of success between antibiotic prescription rates and patient KAB were reported (73 and 70%, respectively). Patient interventions that did not include clinician education were successful to increase KAB but were not shown to decrease antibiotic prescribing. Three interventions targeted reductions in Streptococcus pneumoniae resistance; none were successful.ConclusionsMessaging programs varied in their designs, and many were multifaceted in their approach. These interventions can change patient perspectives regarding antibiotic use, though it is unclear if clinician education is also necessary to reduce antibiotic prescribing. Further investigations are needed to determine the relative influence of interventions focusing on patients and physicians and to determine whether these changes can influence rates of antibiotic resistance long-term

Evaluation of the effect of metformin on the inhibitory effect of oxytocin on potassium chloride stimulated goat ileum

The posterior pituitary hormone, oxytocin is expressed in the myenteric and submucous ganglia and nerve fibers along the entire human gastrointestinal (GI) tract. The role for oxytocin in the physiology and pathophysiology of the bowel remains to be clearly elucidated. Many studies have described that oxytocin exerts stimulatory or inhibitory effects on gut functions. Recently, mRNA for oxytocin and its receptor was found throughout the entire human GI tract. In this study, we examined the responses of the posterior pituitary hormone, oxytocin on the contractile responses to KCl and the effect of metformin on these responses as it affects the glucose transport and causes monoamine release in the gut

An isolated pisiform fracture: a case report

With overall prevalence between 2% to 3%, carpal bone fractures are not encountered frequently in clinical practice. Amongst these, pisiform fractures have very low incidence of <0.2%, in which, more than half are associated with other carpal injuries, and sometimes ulnar styloid and ligamentous injuries. Thus, diagnosis of isolated pisiform fracture requires a very high index of suspicion. Hereby, authors report an isolated pisiform fracture in a 27 year old dentist who sustained an injury due to fall on outstretched hand. After radiographic confirmation in multiple views and CT scan, isolated-minimally displaced pisiform fracture was found. A below-elbow cast with slight palmar flexion was given for 4 weeks. He returned to normal pre-injury activities at 12 weeks

Growth and Dissemination of Endodontic Knowledge

Background: Endodontics is a relatively young clinical specialty that received formal recognition by the American Dental Association in 1963 and by the Commission of Dental Accreditation in 1975. Biological and technological advances have allowed endodontics to evolve into a scientifically based specialty that uses many meticulous methods both at the laboratory and clinical levels. The history, growth and impact of endodontics can be followed by studying the quantity and quality of published literature and comparing it to other dental specialties. Purpose: The aim of this investigation was to use a variety of web based bibliometric tools and describe the growth and dissemination of endodontic knowledge both within and outside the specialty community. Specific aims included quantification of the entire endodontic literature, identification of types of research, analysis of publication patterns and discovery of who has supported and contributed to that knowledge. This overview of endodontic knowledge should provide information on how this may be enhanced in the future. Methods: A series of specific questions were developed that covered many aspects of literature quantification. The value of the literature was assessed by the use of the Impact Factor and citation analysis. Search strategies were developed that could utilize databases such as MEDLINE, Web of Science, Journal Citation Reports and Scopus. Results were summarized using descriptive statistics and by further analysis using linear regression and correlation techniques. Results: MEDLINE has indexed over 35,000 endodontically related papers since 1963. The two journals dedicated to the specialty, the Journal of Endodontics and 3 the International Endodontic Journal both publish more papers on endodontics than any other individual journal yet contain only around 20% of the all endodontic publications. The increase in the total number of research papers published each year in endodontics currently surpasses that in orthodontics and periodontics however, endodontics has fewer higher evidence-­‐based studies compared to periodontics. Government funding was the highest for clinical trials and randomized controlled trials. When analyzing clinical publications within four clinical categories of etiology, diagnosis, prognosis and therapy, endodontics has considerably more papers relating to orthograde root canal therapy compared to any other clinical category. The total number of papers retrieved from the diagnosis clinical category was highest in papers that looked at Periapical disease and similar trends were observed in the prognosis category for papers relating to Endodontic surgery. The significance, of endodontic publications as judged by the Impact Factor has increased substantially over the last ten years when compared to orthodontics and periodontics. The number of citations for endodontic papers has begun to increase rapidly in 2002 especially in the endodontic journals themselves. The majority of endodontic research has originated from the United States, Brazil and England and from small rather than large institutions.Master of ScienceCariology, Restorative Sciences, and EndodonticsDentistry, School ofUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/85729/1/VORA-MS_THESIS_FINAL_2011.pd

Customised Alloy Blends for In-Situ Al339 Alloy Formation Using Anchorless Selective Laser Melting

The additive manufacturing process Selective Laser Melting (SLM) can generate large thermal gradients during the processing of metallic powder; this can in turn lead to increased residual stress formation within a component. Metal anchors or support structures are required to be built during the process and forcibly hold SLM components to a substrate plate and minimise geometric distortion/warpage due to the process induced thermal residual stress. The requirement for support structures can limit the geometric freedom of the SLM process and increase post-processing operations. A novel method known as Anchorless Selective Laser Melting (ASLM) maintains processed material within a stress relieved state throughout the duration of a build. As a result, metal components formed using ASLM do not develop signification residual stresses within the process, thus, the conventional support structures or anchors used are not required to prevent geometric distortion. ASLM locally melts two or more compositionally distinct powdered materials that alloy under the action of the laser, forming into various combinations of hypo/hyper eutectic alloys with a new reduced solidification temperature. This new alloy is maintained in a semi-solid or stress reduced state for a prolonged period during the build with the assistance of elevated powder bed pre-heating. In this paper, custom blends of alloys are designed, manufactured and processed using ASLM. The purpose of this work is to create an Al339 alloy from compositionally distinct powder blends. The in-situ alloying of this material and ASLM processing conditions allowed components to be built in a stress-relieved state, enabling the manufacture of overhanging and unsupported features

Profile Study of Negative Autopsy among the Post Mortem Cases Referred from Medical Officers to Forensic Medicine Department, Ahmedabad, India

Background: The principal aim of an autopsy is to determine the cause of death, and the state of health of the person before he or she died. But in several instances even after detailed autopsy and various laboratory investigations, autopsy surgeon/ Forensic medicine expert cannot determine the cause of death and they end up with negative autopsy. The present study was carried out to find out the types of cases where we were unable to determine cause of death after autopsy at forensic medicine department, B J medical college, civil hospital, Ahmedabad, India.Methods: A total of 251 dead bodies were referred by Medical officers to forensic medicine department, B J medical college, Ahmedabad for expert post mortem examination from 1st January 2011 to 31st December 2015.Results: After thorough and complete post mortem examination, it was found that in 43(17.13%) cases no opinion as to the cause or nature of death could be given. Most common types of cases include decomposition (53.50%), and skeletal remains (23.25%).Conclusion: According to above mentioned facts it is clear that chances of getting cause of death is very poor if time lapse more and more after death like in decomposition and skeletal remains

Osteonecrosis in patients with acute lymphoblastic leukaemia: a national questionnaire study

Objectives: To establish prevalence, management and long-term outcomes of osteonecrosis (ON) in young people diagnosed with acute lymphoblastic leukaemia (ALL) between 2003 and 2011. Design, setting, participants: This study assessed ON in 3113 patients aged 1–24 years who participated in the UK national leukaemia study UKALL 2003. UKALL 2003 recruited patients in 40 UK hospitals between 2003 and 2011 and included patients between ages 1 and 25 diagnosed with ALL. Results: 170 patients were diagnosed with ON, giving a prevalence of 5.5%. The multivariable analysis showed that the risk of ON was highest for children aged between 10 and 20 years (ages 10–15 years, OR 23.7, 95% CI 14.8 to 38.0; ages 16–20 years, OR 22.5, 95% CI 12.7 to 39.8, compared with age <10 years). Among ethnic groups, Asian patients had the highest risk of ON (OR 1.92, 95% CI 1.1 to 3.6, compared with White patients). Eighty-five per cent of patients with ON had multifocal ON. Thirty-eight per cent of patients with ON required surgery and 19% of patients with ON required a hip replacement. Fifteen per cent of patients who had surgery still describe significant disability or use of a wheelchair. Conclusions: ON has considerable morbidity for patients being treated for ALL, with a high burden of surgery. Age and ethnicity were found to be the most significant risk factors for development of ON, with Asian patients and patients aged 10–20 years at diagnosis of ALL at greatest risk. These results will help risk stratify patients at diagnosis of ALL, and help tailor future prospective studies in this area

An immunohistochemical study of altered immunomodulatory molecule expression in head and neck squamous cell carcinoma.

For the presentation of peptide antigens to cytotoxic CD8+ T lymphocytes of the immune system, the expression of human leukocyte antigen (HLA) class I molecules on the cell surface is necessary. There is increasing evidence that surface HLA class I antigen expression is altered in a variety of human tumours by either loss or down-regulation of these molecules, which may be a strategy for evasion of immunosurveillance by malignant cells. This study has examined the expression of HLA class I molecules in head and neck squamous cell carcinoma (HNSCC) specimens by immunohistochemistry, using a wide panel of antibodies directed against allele-specific as well as monomorphic determinants of these molecules. The expression of TAP proteins, HLA-DR and the co-stimulatory molecule ICAM-1 were also studied. In addition, the expression of the tumour-associated antigens (TAA) p53 and MAGE genes was determined. Aberrant allelic expression of HLA class I antigens was detected in 17 out of 34 (50%) of the specimens stained, whereas HLA class I expression determined by W6/32 staining was found to be heterogeneous in only 2 out of 34 (6%) cases. Decreased expression of ICAM-1 was observed in 12 out of 34 (35%) tumour specimens and de novo expression of HLA-DR (HLA class II) by carcinoma cells in 13 out of 34 (38%) cases. Aberrant expression of HLA class I antigens was frequently observed in cases in which MAGE genes and p53 overexpression were detected. The altered expression of these immunomodulatory molecules in HNSCC may affect prognosis and has important implications for peptide-based immunotherapy strategies for these patients