Medical history complexity of patients attending dental student restorative treatment clinics compared with dental emergency clinics

Introduction: Dental students should graduate from undergraduate programmes with the knowledge and skills to safely manage patients. This requires exposure to patients with a range of medical needs, which may impact the planning and delivery of care. Aims and Objectives: We wished to establish the medical history complexity of patients presenting to student restorative clinics and compare them to patients attending a dental emergency clinic. Materials and Methods: We recorded the medical history data of 200 anonymised patients attending student restorative clinics and compared them to previously collected data from 200 dental emergency clinic patients. We collected basic demographic data (age/gender) and noted the number of medical disorders, amount of comorbidity and the number and types of medications for each patient. Results: The age and medical complexity of patients were different, with fewer young patients seen in the dental restorative clinics. Patients attending restorative clinics were more likely to have multiple comorbidities and took greater numbers and types of medications than those seen in dental emergency clinics. Conclusions: For patients seen in student restorative clinics, medical histories are taken once at the beginning of care and the subsequent treatment plan is delivered over many appointments accounting for that medical history. Emergency clinic patients attend for single treatment episodes and their medical complexity is immediately relevant to the treatment offered. Students have multiple, single encounters with patients in emergency clinics. In both clinics, dental treatment plans need to be adjusted to account for patients' drugs and diseases, providing opportunities to consolidate human disease learning

DDX3 depletion represses translation of mRNAs with complex 5' UTRs

DDX3 is an RNA chaperone of the DEAD-box family that regulates translation. Ded1, the yeast ortholog of DDX3, is a global regulator of translation, whereas DDX3 is thought to preferentially affect a subset of mRNAs. However, the set of mRNAs that are regulated by DDX3 are unknown, along with the relationship between DDX3 binding and activity. Here, we use ribosome profiling, RNA-seq, and PAR-CLIP to define the set of mRNAs that are regulated by DDX3 in human cells. We find that while DDX3 binds highly expressed mRNAs, depletion of DDX3 particularly affects the translation of a small subset of the transcriptome. We further find that DDX3 binds a site on helix 16 of the human ribosomal rRNA, placing it immediately adjacent to the mRNA entry channel. Translation changes caused by depleting DDX3 levels or expressing an inactive point mutation are different, consistent with different association of these genetic variant types with disease. Taken together, this work defines the subset of the transcriptome that is responsive to DDX3 inhibition, with relevance for basic biology and disease states where DDX3 is altered

Accounting education/training is overly focused on profit/wealth at the expense of ethics and society

This thesis is a product of the aftermath of the financial crisis, 2008 and the immediate thought that accounting is not caught up misdemeanours. The heartbeat of the thesis is the conceptual framework- legitimacy theory (LT) and an essential part of which is the social contract, the licence for organisations and institutions to operate; therefore, they cannot ignore the public interest aspect. Accounting is littered with ethical scandals, not all of which make the front pages of the press Indeed, behind the headlines and the naming and shaming of organisations are individuals who made unethical decisions. However, the ethics taught at accounting training centres and universities is questionable according to the literature, the survey findings and the interviews from the perspective of the future- final year students (FYSs) and early career professionals (ECPs). Therefore, questioning the content and delivery in academia and training in terms of its effectiveness in combating the adverse side effects of the profit/wealth maximisation mantra- unethical behaviour. Two questionnaires cascade up to 50 questions/statements, making the surveys, to the best of my knowledge the most comprehensive in the area of ethics and accounting. Over 100 ECPs and over 450 FYSs fully completed the surveys. After that, several small focus group interviews again split into ECPs and FYSs. Their views about ethics are mixed- it is unclear whether ethics is understood, and largely based on the code of ethics (CoE). Based on the focus group interviews, ECPs and most FYSs are unaware of legitimacy theory (LT) and the pull of maximising profit/wealth is evident from the surveys and interviews. As such, there is an indication of profit/wealth maximisation over ethics and society that points to business schools and especially employers which will test their legitimacy in the eyes of society. From the evidence contained in this thesis, I call for a re-calibration concerning the pedagogy of ethics to include LT and philosophy and to be provided with its own space in the teaching and training environment. This is for future leaders and decision-makers to understand and absorb ethics and transmit the values of LT and Aristotle’s Phronimos, and to avoid, in the words of Habermas, a legitimisation crisis. In addition, and from the findings, catalysts for change, one which results in a more socially conscious form of capitalism are the influential players the accounting profession and UK business schools

CMV-associated adrenal insufficiency in a renal transplant recipient

Adrenal insufficiency is a rare manifestation of tissue-invasive cytomegalovirus (CMV) disease. CMV is one of the leading opportunistic pathogens affecting renal transplant recipients. Its prevalence in the adrenal glands of autopsied AIDS cases has been well documented. We report a rare case of CMV-associated adrenal insufficiency in a renal transplant recipient

A Retrospective Multi-Center Analysis of Prognostic Factors Determining Outcomes In Patients with Secondary AML

Abstract Abstract 2139 Introduction: Secondary AML (sAML), a well recognized poor prognostic factor in AML, is a heterogeneous group of diseases, including both AML evolving from myelodysplastic syndromes (MDS, MDS→AML) and AML following chemotherapy for another malignancy, i.e. treatment-related AML (tAML). These two subtypes of poor risk AML have similar outcomes when treated with the same cytarabine-based chemotherapy regimen, supporting their inclusion into the same clinical category. A combined data set of patients from a single centre and a phase II study was analyzed to determine which patient and disease factors were of prognostic significance in predicting response to treatment. This is a large data set of sAML patients including patients treated with a variety of cytarabine-based induction regimens. Materials and Methods: Data from 77 newly diagnosed sAML patients treated with cytarabine-based induction chemotherapy at the Cleveland Clinic between 1997 and 2007 and 88 newly diagnosed sAML patients treated with amonafide + cytarabine in a phase II study were combined. The focus of the analysis was to ascertain the prognostic factors affecting overall survival (OS) from time of diagnosis. Initially, univariate Cox proportional hazard models for each prognostic factor were fitted. Hazard ratios and their associated 95% confidence intervals and Wald test p-values were produced. Prognostic factors were: age at diagnosis (<60 years, ≥60 years), gender (male, female), WBC (<20 x109/L, ≥20 x109/L), peripheral blasts (<20%, ≥20%), bone marrow blasts (<40%, ≥40%), cytogenetics CALGB class (unfavorable, intermediate, favorable, unknown), secondary disorder class (MDS, tAML), prior chemotherapy (yes, no), prior radiotherapy (yes, no). Subsequently a multivariate model was produced using the stepwise selection method and a significance level of 5%, having imputed missing data with mean/median values as appropriate. Results: In the combined data set of 165 patients with newly diagnosed sAML, the results for each significant prognostic factor are outlined in the table below. The final multivariate model (displayed in the table below) determined unfavorable cytogenetics, male gender and advanced age as prognostic factors predictive of worse OS. Conclusions: In a combined data set of 178 patients with sAML from 22 US centers, cytogenetics, age and gender were identified as prognostic factors of significance in determining the outcome when treating sAML patients with induction chemotherapy. For patients with these risk factors, additional therapeutic strategies, including early stem cell transplantation, should be considered. Disclosures: Tejura: Antisoma: Employment. Sekeres: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees

E-cigarette aerosol exposure of pulmonary surfactant impairs its surface tension reducing function.

INTRODUCTION: E-cigarette (EC) and vaping use continue to remain popular amongst teenage and young adult populations, despite several reports of vaping associated lung injury. One of the first compounds that EC aerosols comes into contact within the lungs during a deep inhalation is pulmonary surfactant. Impairment of surfactant's critical surface tension reducing activity can contribute to lung dysfunction. Currently, information on how EC aerosols impacts pulmonary surfactant remains limited. We hypothesized that exposure to EC aerosol impairs the surface tension reducing ability of surfactant. METHODS: Bovine Lipid Extract Surfactant (BLES) was used as a model surfactant in a direct exposure syringe system. BLES (2ml) was placed in a syringe (30ml) attached to an EC. The generated aerosol was drawn into the syringe and then expelled, repeated 30 times. Biophysical analysis after exposure was completed using a constrained drop surfactometer (CDS). RESULTS: Minimum surface tensions increased significantly after exposure to the EC aerosol across 20 compression/expansion cycles. Mixing of non-aerosolized e-liquid did not result in significant changes. Variation in device used, addition of nicotine, or temperature of the aerosol had no additional effect. Two e-liquid flavours, menthol and red wedding, had further detrimental effects, resulting in significantly higher surface tension than the vehicle exposed BLES. Menthol exposed BLES has the highest minimum surface tensions across all 20 compression/expansion cycles. Alteration of surfactant properties through interaction with the produced aerosol was observed with a basic e-liquid vehicle, however additional compounds produced by added flavourings appeared to be able to increase inhibition. CONCLUSION: EC aerosols alter surfactant function through increases in minimum surface tension. This impairment may contribute to lung dysfunction and susceptibility to further injury