Oral health education (advice and training) for people with seriousmental illness (Review)

This article will be made Open Access on the publisher's webpage (follow the DOI link) on the 8 September 2016.Background People with serious mental illness not only experience an erosion of functioning in day-to-day life over a protracted period of time, but evidence also suggests that they have a greater risk of experiencing oral disease and greater oral treatment needs than the general population. Poor oral hygiene has been linked to coronary heart disease, diabetes, and respiratory disease and impacts on quality of life, affecting everyday functioning such as eating, comfort, appearance, social acceptance, and self esteem. Oral health, however, is often not seen as a priority in people suffering with serious mental illness. Objectives To review the effects of oral health education (advice and training) with or without monitoring for people with serious mental illness. Search methods We searched the Cochrane Schizophrenia Group’s Trials Register (5November 2015), which is based on regular searches ofMEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the register. Selection criteria All randomised clinical trials focusing on oral health education (advice and training) with or without monitoring for people with serious mental illness. Data collection and analysis We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created ’Summary of findings’ tables using GRADE. Main results We included three randomised controlled trials (RCTs) involving 1358 participants. None of the studies provided useable data for the key outcomes of not having seen a dentist in the past year, not brushing teeth twice a day, chronic pain, clinically important adverse events, and service use. Data for leaving the study early and change in plaque index scores were provided. Oral health education compared with standard care When ’oral health education’ was compared with ’standard care’, there was no clear difference between the groups for numbers leaving the study early (1 RCT, n = 50, RR 1.67, 95%CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may have implications regarding improvement in oral hygiene. Motivational interview + oral health education compared with oral health education Similarly, when ’motivational interview + oral health education’ was compared with ’oral health education’, there was no clear difference for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60 95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding improvement in oral hygiene. Monitoring compared with no monitoring For this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring the ’no monitoring’ group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection of the acceptability of the monitoring to patients. For this comparison, no data were available for ’no clinically important change in plaque index’. Authors’ conclusions We found no evidence from trials that oral health advice helps people with serious mental illness in terms of clinically meaningful outcomes. It makes sense to follow guidelines and recommendations such as those put forward by the British Society for Disability and Oral Health working group until better evidence is generated. Pioneerin

Nucleus Accumbens Deep Brain Stimulation in a Rat Model of Binge Eating

Binge eating (BE) is a difficult-to-treat behavior with high relapse rates, thus complicating several disorders including obesity. In this study, we tested the effects of high-frequency deep brain stimulation (DBS) in a rodent model of BE. We hypothesized that BE rats receiving high-frequency DBS in the nucleus accumbens (NAc) core would have reduced binge sizes compared with sham stimulation in both a \u27chronic BE\u27 model as well as in a \u27relapse to chronic BE\u27 model. Male Sprague-Dawley rats (N=18) were implanted with stimulating electrodes in bilateral NAc core, and they received either active stimulation (N=12) or sham stimulation (N=6) for the initial chronic BE experiments. After testing in the chronic BE state, rats did not engage in binge sessions for 1 month, and then resumed binge sessions (relapse to chronic BE) with active or sham stimulation (N=5-7 per group). A significant effect of intervention group was observed on binge size in the chronic BE state, but no significant difference between intervention groups was observed in the relapse to chronic BE experiments. This research, making use of both a chronic BE model as well as a relapse to chronic BE model, provides data supporting the hypothesis that DBS of the NAc core can decrease BE. Further research will be needed to learn how to increase the effect size and decrease deep brain stimulation-treatment outcome variability across the continuum of BE behavior

1,2-diaminocyclohexane-platinum complexes with antitumor activity

The present invention comprises a water-soluble square-planar cis-platinum(II) four-coordinate complex having the formula: EQU trans-R,R-DACH Pt(II) X.sub.2 or EQU trans-R,R-DACH Pt(II) Y wherein X is a monovalvent cation, two of which are present, selected from the group consisting of cyclopropanecarboxylato, shikimato, saccharatolactone, galacturonato and N,N-dimethyglycinato; wherein Y is a divalent cation selected from the group consisting of citraconato, 1,1-cyclobutanedicarboxylato, 1,1-cyclopropanedicarboxylato, isocitratolactone and Z-iminodiacetato where Z is bound to the nitrogen and is ethyl, propyl, Isopropyl, n-butyl, sec-butyl, ter-butyl, n-amyl, isoamyl or OH. In one preferred aspect the water-soluble square-planar cis-platinum(II) four-coordinate complex has the formula: EQU trans-R,R-DACH Pt(II) X.sub.2 wherein X is a monovalent cation. Two X substituents are present in the platinum complex. These X substituents are preferably selected from the group consisting of cyclopropanecarboxylato, shikimato, saccharatolactone, galacturonato and N,N-dimethylglycinato. Both X substituents are usually identical butmay be different.Board of Regents, University of Texas Syste

Development of delamination in cross-ply laminates: effect of microstructure

Various aspects of the effect of microstructural randomness exhibited by carbon fibre-reinforced cross-ply laminates on the delamination damage mechanism is investigated in this paper. In the first part, the matrix cracks with different spacings measured in experiments are simulated using finite elements in order to obtain the levels of degradation and effective properties for a composite beam loaded in bending. The results show significant levels of degradation of obtained effective properties depicting the importance of accounting for the inherent stochasticity in these laminates. In the second part of the paper, initiation of delamination at an interface between 0° and 90° layers due to stress concentrations at tips matrix cracks is simulated for a beam under tension. Stochastic cohesive zone elements with fracture parameters presented as random fields are used to model this interface in a composite. Different values of the axial stress are obtained for initiation of damage for a number of realisations based on this approach. The results emphasize the need to take into consideration the microstructural randomness in fibre-reinforced laminates for adequate predictions of damage and load carrying capacities

Simulations of delamination in CFRP laminates: effect of microstructural randomness

Due to their high specific strength and stiffness, fibre-reinforced composite materials are being increasingly used in structural applications where a high level of performance is important (e.g. aerospace, automotive, offshore structures, etc.). Performance in service of these composites is affected by multi-mechanism damage evolution under loading and environmental conditions. For instance, carbon fibre-reinforced laminates demonstrate a wide spectrum of failure mechanisms such as matrix cracking and delamination. These damage mechanisms can result in significant deterioration of the residual stiffness and load-bearing capacity of composite components and should be thoroughly investigated. The delamination failure mechanism is studied in this paper for a double cantilever beam (DCB) loaded in Mode I. Several sensitivity studies are performed to analyse the effects of mesh density and of parameters of the cohesive law on the character of damage propagation in laminates. The microstructural randomness of laminates that is responsible for non-uniform distributions of stresses in them even under uniform loading conditions is accounted for in the model. The random properties are introduced with the use of Weibull’s two-parameter probability density function. Several statistical realisations are carried out which show that the effect of microstructure could significantly affect the macroscopic response emphasizing the need to account for microstructural randomness for accurate predictions of load-carrying capacity of laminate composite structures

Three-dimensional analysis of the effect of material randomness on the damage behaviour of CFRP laminates with stochastic cohesive-zone elements

Laminated carbon fibre-reinforced polymer (CFRP) composites are already well established in structural applications where high specific strength and stiffness are required. Damage in these laminates is usually localised and may involve numerous mechanisms, such as matrix cracking, laminate delamination, fibre de-bonding or fibre breakage. Microstructures in CFRPs are non-uniform and irregular, resulting in an element of randomness in the localised damage. This may in turn affect the global properties and failure parameters of components made of CFRPs. This raises the question of whether the inherent stochasticity of localised damage is of significance in terms of the global properties and design methods for such materials. This paper presents a numerical modelling based analysis of the effect of material randomness on delamination damage in CFRP materials by the implementation of a stochastic cohesive-zone model (CZM) within the framework of the finite-element (FE) method. The initiation and propagation of delamination in a unidirectional CFRP double-cantilever beam (DCB) specimen loaded under mode-I was analyzed, accounting for the inherent microstructural stochasticity exhibited by such laminates via the stochastic CZM. Various statistical realizations for a half-scatter of 50 % of fracture energy were performed, with a probability distribution based on Weibull's two-parameter probability density function. The damaged area and the crack lengths in laminates were analyzed, and the results showed higher values of those parameters for random realizations compared to the uniform case for the same levels of applied displacement. This indicates that deterministic analysis of composites using average properties may be non-conservative and a method based on probability may be more appropriate. © 2013 Springer Science+Business Media Dordrecht

Sex Differences in the Behavioural Outcomes of Prenatal Nicotine and Tobacco Exposure

Smoking remains the leading cause of preventable death worldwide. A combination of biological and environmental risk factors make women especially vulnerable to nicotine addiction, making it harder for them to quit smoking. Smoking during pregnancy, therefore, is still a major health concern, with epidemiological data suggesting a role for gestational nicotine exposure in the development of several behavioural disorders. Given there are significant sex-specific behavioural outcomes related to smoking in adolescence and adulthood, it is probable that the behavioural outcomes following gestational nicotine or tobacco exposure are similarly sex-dependent. This is an especially relevant topic as the current landscape of nicotine use shifts toward vaping, a mode of high doses of nicotine delivery that is largely believed to be a safer alternative to cigarettes among the public as well as among pregnant women. Here we review existing clinical and preclinical findings regarding the sex-dependent behavioural outcomes of prenatal nicotine exposure. We also highlight the challenges within this literature, particularly those areas in which further research is necessary to improve consistency within, and between, clinical and preclinical findings