Perception of Patient Cooperation Among Dentist, Guardian, and Child

Purpose: Evaluate behavior assessment and agreement among dentist, guardian, and child. Evaluate child behavior by appointment type. Methods: Patients recruited from the pediatric dental department at Virginia Commonwealth University for this convenience sample. Inclusion criteria: patients presenting for clinical exams and/or restorative treatment without the use of advanced behavior guidance between August 29, 2018, and March 7, 2019; ages 4-12-years-old; and scheduled with a single clinician. Appointments were stratified by difficulty. Behavior was assessed by dentist and caregiver using the Frankl Scale. Patient self-assessed cooperation using an age-appropriate modified Frankl Scale, developed for this study. Agreement assessed among the 3 scores at each appointment using descriptive statistics and Cohen’s Kappa. Behavior trends across appointment type assessed using Kruskal-Wallis test. SAS software (2013, Cary, NC). P-value \u3c 0.05. Results: Forty-one patient-guardian dyads enrolled in the study. Five dyads experienced multiple encounters. Demographics for the patients enrolled: 59% male; 44% Caucasian, 29% African American, 5% Asian, 2% Hispanic, 20% other/multiracial. Average patient age: 7.6 (range: 4- 12). Most patients had 1 encounter (n=36, 88%). Frankl Score agreement for provider/guardian was 79% (k=0.335), provider/child was 70% (k=0.248), and guardian/child was 81% (k=0.314). In disagreements, guardians rated behavior better than provider. Disagreement was split for provider/child and guardian/child, with the child tending to rate themselves higher, and the guardian tending to rate the child higher respectively. Marginal evidence that hard appointments resulted in poorer behaviors. Conclusion: There is fair agreement between child, guardian, and provider. In disagreements, guardians tend to rate the child’s behavior better compared to the provider and child self-assessment. Dental providers tend to be more critical of patient behavior. Marginal evidence to support harder appointments result in poorer behaviors

Injury in Ireland

Injury mortality is the fourth commonest cause of death in Ireland. The treatment of injuries has a major impact on our hospitals and on our budget for health. Long term disability following accidents is a serious problem. The aim of this report is to examine the impact of accidents and injuries on the Irish population by analysing routine mortality and morbidity data, and to identify in turn those areas where preventive measures could have an impact. In Section One the literature review details the advantages and disadvantages of each type of routine data source used in this report. The interpretation of data should take account of the constraints of the available data collected. The usefulness of routine data collection is highlighted, while identifying areas for improvement. In Section Two the methodology employed in the study is detailed. In Section Three data on hospital admissions over a five-year period 1993-1997 are presented. An overview of injury admissions is presented, followed by further analysis of injury data by both cause and by age group. In Section Four data on all accident-related deaths over a 17-year period, 1980-1996, are presented, with overall mortality data and mortality data by age group and by major causes of injury death detailed. In Section Five comparisons are made between the eight health board regions for rates of admissions and deaths due to injury. In presenting the data we use a matrix format devised and recommended by the International Collaborative Effort on Injury Statistics to display injury simultaneously by cause and intent. The use of a common format will also facilitate regional and international comparisons. In Section Six the priority recommendations for injury prevention are outlined. The key findings are then discussed and further recommendations are presented with the aim of injury prevention, reduction of disability and improvement in injury surveillance

Advanced Fenton processing of aqueous phenol solutions:a continuous system study including sonication effects

Our previous report based on a batch reactor system for the Advanced Fenton Process (AFP) showed that pH, hydrogen peroxide and the organic substances treated are among the most important factors affecting the oxidation efficiency. As an extended study towards its commercialisation, this paper reports the effects of the main process parameters including those relating to a new AFP flow-through system. In order to systemise and correlate the results, the Taguchi experimental design method was used. Total organic carbon (TOC) removal was utilised as the measure of the oxidation efficiency and it was found that the removal of phenol from aqueous solution at pH 2.0 and 2.5 was very similar but hydrogen peroxide supply significantly affected the TOC removal with the change of flow rate from 14.4 mL/hr to 60 mL/hr. Also, the initial concentration of phenol was a highly significant factor, with higher concentrations resulting in a lower TOC removal rate. The temperature effects in the range of 14 °C to 42 °C were investigated and it was found that there was accelerated oxidation of phenol in the early stages but after 90 minutes there was no significant difference between the results. Sonication with a bath type sonicator resulted in relatively small enhancements of TOC removal but further studies with cup-horn and probe type sonicators showed that TOC removal increased with higher intensity of sonication on additional input of hydrogen peroxide

Artemether resistance in vitro is linked to mutations in PfATP6 that also interact with mutations in PfMDR1 in travellers returning with Plasmodium falciparum infections.

BACKGROUND: Monitoring resistance phenotypes for Plasmodium falciparum, using in vitro growth assays, and relating findings to parasite genotype has proved particularly challenging for the study of resistance to artemisinins. METHODS: Plasmodium falciparum isolates cultured from 28 returning travellers diagnosed with malaria were assessed for sensitivity to artemisinin, artemether, dihydroartemisinin and artesunate and findings related to mutations in pfatp6 and pfmdr1. RESULTS: Resistance to artemether in vitro was significantly associated with a pfatp6 haplotype encoding two amino acid substitutions (pfatp6 A623E and S769N; (mean IC50 (95% CI) values of 8.2 (5.7 - 10.7) for A623/S769 versus 623E/769 N 13.5 (9.8 - 17.3) nM with a mean increase of 65%; p = 0.012). Increased copy number of pfmdr1 was not itself associated with increased IC50 values for artemether, but when interactions between the pfatp6 haplotype and increased copy number of pfmdr1 were examined together, a highly significant association was noted with IC50 values for artemether (mean IC50 (95% CI) values of 8.7 (5.9 - 11.6) versus 16.3 (10.7 - 21.8) nM with a mean increase of 87%; p = 0.0068). Previously described SNPs in pfmdr1 are also associated with differences in sensitivity to some artemisinins. CONCLUSIONS: These findings were further explored in molecular modelling experiments that suggest mutations in pfatp6 are unlikely to affect differential binding of artemisinins at their proposed site, whereas there may be differences in such binding associated with mutations in pfmdr1. Implications for a hypothesis that artemisinin resistance may be exacerbated by interactions between PfATP6 and PfMDR1 and for epidemiological studies to monitor emerging resistance are discussed

‘I don’t want anybody to see me using it’: cashless welfare cards do more harm than good

The Australian government touts compulsory income management as a way to stop welfare payments being spent on alcohol, drugs or gambling