Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting

Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma

Multiple myeloma is a malignant B-cell neoplasm that involves the skeleton in approximately 80% of the patients. With an average age of 60 years and a 5-years survival of nearly 45% Brenner et al. (Blood 111:2516–2520, 35) the onset is to be classified as occurring still early in life while the disease can be very aggressive and debilitating. In the last decades, several new imaging techniques were introduced. The aim of this review is to compare the different techniques such as radiographic survey, multidetector computed tomography (MDCT), whole-body magnetic resonance imaging (WB-MRI), fluorodeoxyglucose positron emission tomography- (FDG-PET) with or without computed tomography (CT), and 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy. We conclude that both FDG-PET in combination with low-dose CT and whole-body MRI are more sensitive than skeleton X-ray in screening and diagnosing multiple myeloma. WB-MRI allows assessment of bone marrow involvement but cannot detect bone destruction, which might result in overstaging. Moreover, WB-MRI is less suitable in assessing response to therapy than FDG-PET. The combination of PET with low-dose CT can replace the golden standard, conventional skeletal survey. In the clinical practise, this will result in upstaging, due to the higher sensitivity

Tracking reveals limited interactions between Campbell Albatross and fisheries during the breeding season

International audienceFisheries-related mortality has been influential in driving global declines in seabird populations. Understanding the overlap between seabird distribution and fisheries is one important element in assessing bycatch risk, and may be achieved by tracking the movements of individual birds and fishing vessels. Here, we assess the spatiotemporal overlap between the vulnerable Campbell Albatross Thalassarche impavida and large (>28 m) commercial fishing boats in New Zealand’s Exclusive Economic Zone (EEZ). We used a novel analytical approach, bivariate Gaussian bridge movement modelling, to compute spatiotemporal utilization distributions of bird-borne global positioning system (GPS) loggers and data from the Vessel Monitoring System. We tracked birds for 28,815 h during incubation and chick brooding, with half of this time spent within New Zealand’s EEZ, utilizing 6.7% of the available area. However, there was no evidence that albatrosses and fishing vessels were in the same location simultaneously. We accounted for the broader ecological footprint of fishing vessels by calculating the distance between GPS-fix locations for albatrosses and fishing vessels, revealing that albatrosses were within 30 km of fishing vessels in 8.4% of foraging trips. This highlights differences in estimated fine-scale spatiotemporal overlaps which may be due to the distance between albatrosses and vessels or the methods used. Overall, the low levels of spatial overlap could be a result of Campbell Albatross’ preference for foraging in areas without fishing activity or competitive exclusion by other species. Our results reinforce the importance of multi-scale, temporally explicit, and multi-national approaches to risk assessment, as Campbell Albatrosses spend approximately half of their time foraging outside New Zealand’s EEZ

MMO morality

When people sign up to play a game, they have broad expectations as to what will be involved in terms of time commitment, gameplay, skill requirements, genre and atmosphere. If the game does not meet their standards, they don’t play. This is as true of massively multiplayer online role-playing games (MMOs) as it is of Monopoly. Otherwise, so long as what you’re asked to do sits within the boundaries of your expectations, you can happily immerse yourself. Sometimes, however, you may be asked during play to do something outside what you thought were the boundary lines. For example, if you were enjoying a cerebral role-playing game and suddenly discovered that in order to progress you had to undertake a fast-reactions, high-speed racing mini-game, your level of engagement might be compromised (Yes, I’m talking to you, Knights of the Old Republic). When this kind of thing happens, you are tugged out of the game back into reality; you then have to make the decision as to whether to carry on playing or not. This chapter considers one particular kind of expectation held by players of MMOs - the morality imbued in the game world’s fiction - and examines problems that can arise when the views of players and the game’s designer fall out of step. It concludes with an assessment of what this means for the morality of game design itself

A Comprehensive Persona Template to Understand Citizens' Mobility Needs

In the city of Kaiserslautern, an urban district is being built, that aims to be climate-neutral. To achieve this aim, innovative concepts and technologies for energy generation and mobility services are to be applied. For the mobility concept, we needed personas as inhabitants and stakeholders are not living there yet. Since we could not find a persona template for the documentation of travelers’ needs, we designed a persona template that provides a comprehensive picture of travel needs. We took a template based on Alan Cooper’s idea and customized it to fit the topic of mobility, adding personality traits that are the basis of concrete mobility requirements. We also added characteristics of a person according to their stage of life, because personality traits hardly change over a person’s lifetime. In addition, we included attitudes towards sustainability and technology. A description of the life situation together with the usual travel destinations and trip companions is also part of the persona template. The design of our template allows it to be used in other projects as well. We created personas based on our template and used them in two different workshops. The participants were able to use the personas without much explanation. A plan for further evaluation is presented in the discussion