An Update on the Management of Endodontic Biofilms Using Root Canal Irrigants and Medicaments

Microbial biofilm is defined as a sessile multicellular microbial community characterized by cells that are firmly attached to a surface and enmeshed in a self-produced matrix of extracellular polymeric substances. Biofilms play a very important role in pulp and periradicular pathosis. The aim of this article was to review the role of endodontic biofilms and the effects of root canal irrigants, medicaments as well as lasers on biofilms. A Medline search was performed on the English articles published from 1982 to 2013 and was limited to papers published in English. The searched keywords were “Biofilms AND endodontics”, “Biofilms AND sodium hypochlorite”, "Biofilms AND chlorhexidine", "Biofilms AND MTAD", "Biofilms AND calcium hydroxide", “Biofilms AND ozone”, “Biofilms AND lasers” and "Biofilms AND nanoparticles". The reference list of each article was manually searched to find other suitable sources of information

A Review of the Various Surface Treatments of NiTi Instruments

Since the introduction of engine-driven nickel-titanium (NiTi) instruments, attempts have been made to minimize or eliminate their inherent defects, increase their surface hardness/flexibility and also improve their resistance to cyclic fatigue and cutting efficiency. The various strategies of enhancing instrument surface include ion implantation, thermal nitridation, cryogenic treatment and electropolishing. The purpose of this paper was to review the metallurgy and crystal characteristics of NiTi alloy and to present a general over review of the published articles on surface treatment of NiTi endodontic instruments

A Review of the Properties and Applications of Ozone in Endodontics: An Update

Ozone is a triatomic molecule consisting of three oxygen atoms. It is applied to oral tissues in the forms of ozonated water, ozonated olive oil and oxygen/ozone gas. This paper presents a brief review on the chemistry of ozone as well as its medical and dental applications focusing on its use in endodontics. Ozone’s antimicrobial activity, its effect on dentin bonding, toxicity and contra-indications are also reviewed

Integration of Remote Patient Monitoring Systems into Physicians Work in Underserved Communities: Survey of Healthcare Provider Perspectives

Remote patient monitoring (RPM) technologies have been identified as a viable alternative to improve access to care in underserved communities. Successful RPM platforms are designed and implemented for seamless integration into healthcare providers work to increase adoption and availability for offering remote care. A quantitative survey was designed and administered to elicit perspectives from a wide range of stakeholders, including healthcare providers and healthcare administrators, about barriers and facilitators in the adoption and integration of RPM into clinical workflows in underserved areas. Ease of adoption, workflow disruption, changes in the patient-physician relationship, and costs and financial benefits are identified as relevant factors that influence the widespread use of RPM by healthcare providers; significant communication and other implementation preferences also emerged. Further research is needed to identify methods to address such concerns and use information collected in this study to develop protocols for RPM integration into clinical workflow

A Wearable, Low-cost Hand Tremor Sensor for Detecting Hypoglycemic Events in Diabetic Patients

Severe hypoglycemia leverages complication in diabetes patients: e.g., it increases death rate by a six-fold. Therefore, early detection and prediction of hypoglycemic events are of utmost importance. This publication presents a prototype of a wearable hand-tremor system that detects the onset of hypoglycemic events. The results show the prototype is capable of simulating anticipated frequency and amplitude of the tremor relevant for hypoglycemic events. The initial functional performance-tests demonstrate a maximum error of 4.75% in the detecting the tremor frequency

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

BACKGROUND: Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common. METHODS: Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA. RESULTS: We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died. CONCLUSION: Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality

Human knockouts and phenotypic analysis in a cohort with a high rate of consanguinity

A major goal of biomedicine is to understand the function of every gene in the human genome. Loss-of-function mutations can disrupt both copies of a given gene in humans and phenotypic analysis of such 'human knockouts' can provide insight into gene function. Consanguineous unions are more likely to result in offspring carrying homozygous loss-of-function mutations. In Pakistan, consanguinity rates are notably high. Here we sequence the protein-coding regions of 10,503 adult participants in the Pakistan Risk of Myocardial Infarction Study (PROMIS), designed to understand the determinants of cardiometabolic diseases in individuals from South Asia. We identified individuals carrying homozygous predicted loss-of-function (pLoF) mutations, and performed phenotypic analysis involving more than 200 biochemical and disease traits. We enumerated 49,138 rare (<1% minor allele frequency) pLoF mutations. These pLoF mutations are estimated to knock out 1,317 genes, each in at least one participant. Homozygosity for pLoF mutations at PLA2G7 was associated with absent enzymatic activity of soluble lipoprotein-associated phospholipase A2; at CYP2F1, with higher plasma interleukin-8 concentrations; at TREH, with lower concentrations of apoB-containing lipoprotein subfractions; at either A3GALT2 or NRG4, with markedly reduced plasma insulin C-peptide concentrations; and at SLC9A3R1, with mediators of calcium and phosphate signalling. Heterozygous deficiency of APOC3 has been shown to protect against coronary heart disease; we identified APOC3 homozygous pLoF carriers in our cohort. We recruited these human knockouts and challenged them with an oral fat load. Compared with family members lacking the mutation, individuals with APOC3 knocked out displayed marked blunting of the usual post-prandial rise in plasma triglycerides. Overall, these observations provide a roadmap for a 'human knockout project', a systematic effort to understand the phenotypic consequences of complete disruption of genes in humans.D.S. is supported by grants from the National Institutes of Health, the Fogarty International, the Wellcome Trust, the British Heart Foundation, and Pfizer. P.N. is supported by the John S. LaDue Memorial Fellowship in Cardiology from Harvard Medical School. H.-H.W. is supported by a grant from the Samsung Medical Center, Korea (SMO116163). S.K. is supported by the Ofer and Shelly Nemirovsky MGH Research Scholar Award and by grants from the National Institutes of Health (R01HL107816), the Donovan Family Foundation, and Fondation Leducq. Exome sequencing was supported by a grant from the NHGRI (5U54HG003067-11) to S.G. and E.S.L. D.G.M. is supported by a grant from the National Institutes of Health (R01GM104371). J.D. holds a British Heart Foundation Chair, European Research Council Senior Investigator Award, and NIHR Senior Investigator Award. The Cardiovascular Epidemiology Unit at the University of Cambridge, which supported the field work and genotyping of PROMIS, is funded by the UK Medical Research Council, British Heart Foundation, and NIHR Cambridge Biomedical Research Centre ... Fieldwork in the PROMIS study has been supported through funds available to investigators at the Center for Non-Communicable Diseases, Pakistan and the University of Cambridge, UK

The Effect of a Longitudinal Intervention to Influence Participants’ Beliefs, Intention, and Actual Behavior Performed within a Health Context

Millions of people across the globe live with chronic conditions such as obesity (1.9 billion) (World Health Organization, 2018) and diabetes (420 million) (World Health Organization, 2016). This leads to burdening costs on the economy of at least $190 billion (Economic Costs of Obesity | Healthy Communities for a Healthy Future, n.d.), and$327 billion respectively (Centers for Disease Control and Prevention, 2018). An unhealthy lifestyle that includes unhealthy food choices and behaviors such as low physical activity may be contribute to the development of these conditions (Healthdirect Australia, 2018; Lin et al., 2012). Emerging technologies such as mobile health (mHealth) have shown promise in providing a platform to interact with and motivate patients to adhere to a particular self-care regimen, or to change their behavior. However, limited long-term engagement and attrition remain common bottlenecks limiting the success of related interventions. To improve our understanding of what contributes to adherence and engagement with positive health-related behaviors, several approaches have been proposed. Among them, understanding behavioral characteristics and beliefs has shown promise in predicting intention to perform such behaviors. However, this emerging body of literature is limited and requires a deeper understanding of the efficacy of using behavioral constructs to investigate intentions and actual engagement with interventions aimed at forming healthy habits or improving self-care. Therefore, my research efforts were to investigate the behavioral models and constructs that may help understand intention to use a technology to help promote a healthy behavior. To do so, I performed a review of the health beliefs models and theories used to assess usage of technology within the health context, and showed that the Technology Acceptance Model (TAM) is the most commonly used model to understand usage of technology. Additionally, a few studies recommended the Health Belief Model (HBM) to be used in conjunction with TAM in order to improve prediction of user intention. Next, the review identified important gaps in the literature starting with the fact that that beliefs are assessed at one point in time only, and that there is limited comparison of intention and actual behaviors. Following the review, four studies were conducted to address these gaps. Study #1 conducted a nationwide survey of patients with Type 1 Diabetes to assess the relationships between belief constructs and intentions to use a diabetes management technology. The next three studies were conducted to assess changes in behavioral constructs and their efficacy in predicting behavior over time. Study #2 assessed night-shift nurses’ beliefs and attitude towards an intervention to support them in avoiding drowsy driving. Study #2 revealed significant changes in nurses’ beliefs and attitudes towards an intervention that utilized education and a drowsy driving detection technology to alert nurses when they were driving drowsy. Study #3 evaluated changes in belief constructs in the context of assessing an mHealth app that helped participants self-manage their hypertension. Study #3 highlighted significant relationships between beliefs and adherence to BP measurements as well as clinical outcomes. Finally, Study #4 utilized similar methods to provide mHealth coaching to college students to enable them to self-manage their mental health. The study found significant relationships between participants’ self-efficacy and mental health outcomes, as well as significant differences in belief means across different levels of engagement with the app. The findings from this dissertation suggest that (1) the synthesized model borrowing behavioral constructs from the HBM and TAM helps significantly predict intention, (2) certain beliefs (e.g., self-efficacy, cues to action) may significantly change as a result of an intervention, (3) some of the beliefs (e.g., attitude, perceived health threat) are recurrently identified as significant predictors of intention across several studies and health contexts, and (4) behaviors and outcomes may be influenced by behavioral constructs such as self-efficacy, perceived health threat, and perceived ease of use

Use of a Mobile Biofeedback App to Provide Health Coaching for Stress Self-management: Pilot Quasi-Experiment

BackgroundMental health is an increasing concern among vulnerable populations, including college students and veterans. ObjectiveThe purpose of this study was to determine if mobile health technology combined with health coaching can better enable a user to self-manage their mental health. MethodsThis study evaluated the mobile app “Biofeedback” that provided health coaching on stress self-management for college student veterans’ mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep-breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives and a smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at 2-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile biofeedback app. ResultsThe deep-breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants’ heart rate during the 6-minute time period immediately after conducting the breathing exercises (Spearman rank correlation coefficient –0.61, P<.001; S=9,816,176). There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicated that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. ConclusionsParticipants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app