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The influence of adding modified zirconium oxide-titanium dioxide nano-particles on mechanical properties of orthodontic adhesive: an in vitro study
No full textAbstract
Background
The purpose of this in-vitro study was to examine the effect of incorporating different concentrations of Zirconium oxide-Titanium dioxide (ZrO2-TiO2) nanoparticles, which can have antibacterial properties, on the mechanical properties of an orthodontic adhesive.
Methods
ZrO2-TiO2 (Zirconium oxide, HWNANO, Hongwu International Group Ltd, China) -Titanium dioxide, Nanoshell, USA) nanopowder were incorporated into orthodontic adhesive (Transbond XT, 3\ua0M Unitek, Monrovia, USA) with different concentrations (0.5% weight nonofiller and 1% weight nanofiller). The size of nanoparticle was 70\u201380\ua0nm for ZrO2 and less than 50\ua0nm for TiO2. For measuring the shear bond strength of the three groups of orthodontic adhesives [Transbond (control), Transbond mixed with 0.5% weight ZrO2-TiO2, and Transbond mixed with 1% weight ZrO2-TiO2], 30 freshly extracted human first premolars were used and bonded with stainless steel metal brackets (Dentaurum\uae, Discovery\uae, Deutschland), using the 3 orthodontic adhesives and 3\ua0M Unitek; Transbond TM Plus Self-Etching Primer (10 samples in each group). The recorded values of compressive strength and tensile strength (measured separately on 10 samples of orthodontic adhesives (add the 3 D size of sample, light cured for 40\ua0s on both sides) of each orthodontic adhesives), as well as the shear bond strength in Mega Pascal unit (MPa) were collected and exposed to one-way analysis of variance (ANOVA) and Tukey\u2019s post-hoc tests.
Results
orthodontic adhesive with 1% weight ZrO2-TiO2 showed the highest mean compressive (73.42\u2009\ub1\u20091.55\ua0MPa, p: 0.003, F: 12.74), tensile strength (8.65\u2009\ub1\u20090.74\ua0MPa, p: 0.001, F: 68.20), and shear bond strength (20.05\u2009\ub1\u20090.2\ua0MPa, p: 0.001, F: 0.17).
Conclusions
Adding ZrO2-TiO2 nanoparticle to orthodontic adhesive increased compressive strength, tensile strength, and shear bond strength in vitro, but in vivo studies and randomized clinical trials are needed to validate the present findings
Validity evidence for two objective structured clinical examination stations to evaluate core skills of the shoulder and knee assessment
No full textAbstract
Background
We developed two objective structured clinical examinations (OSCEs) to educate and evaluate trainees in the evaluation and management of shoulder and knee pain. Our objective was to examine the evidence for validity of these OSCEs.
Methods
A multidisciplinary team of content experts developed checklists of exam maneuvers and criteria to guide rater observations. Content was proposed by faculty, supplemented by literature review, and finalized using a Delphi process. One faculty simulated the patient, another rated examinee performance. Two faculty independently rated a portion of cases. Percent agreement was calculated and Cohen\u2019s kappa corrected for chance agreement on binary outcomes. Examinees\u2019 self-assessment was explored by written surveys. Responses were stratified into 3 categories and compared with similarly stratified OSCE scores using Pearson\u2019s coefficient.
Results
A multi-disciplinary cohort of 69 examinees participated. Examinees correctly identified rotator cuff and meniscal disease 88% and 89% of the time, respectively. Inter-rater agreement was moderate for the knee (87%; k\u2009=\u20090.61) and near perfect for the shoulder (97%; k\u2009=\u20090.88). No correlation between stratified self-assessment and OSCE scores were found for either shoulder (0.02) or knee (\u22120.07).
Conclusions
Validity evidence supports the continuing use of these OSCEs in educational programs addressing the evaluation and management of shoulder and knee pain. Evidence for validity includes the systematic development of content, rigorous control of the response process, and demonstration of acceptable interrater agreement. Lack of correlation with self-assessment suggests that these OSCEs measure a construct different from learners\u2019 self-confidence
Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service
No full textAbstract
Background
Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia.
Methods
Donabedian\u2019s structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings.
Results
Structural dimensions identified included the \u2018in-reach\u2019 nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction.
Conclusions
This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands
Healthcare system responsiveness in Jiangsu Province, China
No full textAbstract
Background
The perceived responsiveness of a healthcare system reflects its ability to satisfy reasonable expectations of the public with respect to non-medical services. Recently, there has been increasing attention paid to responsiveness in evaluating the performance of a healthcare system in a variety of service settings. However, the factors that affect the responsiveness have been inconclusive so far and measures of improved responsiveness have not always thoroughly considered the factors. The aim of this study was to evaluate both the responsiveness of the healthcare system in Jiangsu Province, China, the factors that influence responsiveness and the measures of improved responsiveness considering it, as determined by a responsiveness survey.
Methods
A multistage, stratified random sampling method was used to select 1938 adult residents of Jiangsu Province in 2011. Face-to-face interviews were conducted using a self-designed questionnaire modeled on the World Health Organization proposal. The final analysis was based on 1783 (92%) valid questionnaires. Canonical correlation analysis was used to assess the factors that affect responsiveness.
Results
The average score of all responsiveness-related domains in the surveyed healthcare system was satisfactory (7.50 out of a maximum 10.0). The two highest scoring domains were dignity and confidentiality, and the two lowest scoring domains choice and prompt attention. The factors affecting responsiveness were age, regional economic development level, and geographic area (urban vs. rural). The responsiveness regarding basic amenities was rated worse by the elderly than by younger respondents. Responsiveness ranked better by those with a poorer economic status. Choice in cities was better than in rural regions.
Conclusions
The responsiveness of the Jiangsu healthcare system was considered to be satisfactory but could be improved by offering greater choice and providing more prompt attention. Perceptions of healthcare system responsiveness differ with age, regional economic development level, and geographic area (urban vs. rural). Measures to increase the perceived level of responsiveness include better service at higher level hospitals, shorter waiting time, more hospitals in rural regions, an improved medical environment, and provision of infrastructures that makes the medical environments more comfortable
The Journal Impact Factor is under attack \u2013 use the CAPCI factor instead
No full textAbstract
The uses and misuses of the Journal Impact Factor (JIF) have been thoroughly discussed in the literature. A few years ago, I predicted that JIF would soon be replaced, while another colleague argued the opposite. Over the past few months, attacks on JIF have intensified, with some publishing organizations gradually removing the indicator from their journals\u2019 websites. Here, I argue that most, if not all of the misuses of JIF are related to its name. The word \u201cimpact\u201d should be removed, since it implies an influential attribute, either for the journals, their published papers, or their authors. I propose instead the use of a new name, the \u201cCAPCI factor\u201d, standing for Citation Average Per Citable Item, which accurately describes what is represented by this measure
Detection of Plasmodium knowlesi, Plasmodium falciparum and Plasmodium vivax using loop-mediated isothermal amplification (LAMP) in a co-endemic area in Malaysia
No full textAbstract
Background
Plasmodium knowlesi is the most common cause of malaria in Malaysia. However, microscopic diagnosis is inaccurate and rapid diagnostic tests (RDTs) are insufficiently sensitive. PCR is sensitive and specific but not feasible at a district level. Loop-mediated isothermal amplification (LAMP) shows potential with only basic requirements. A commercially available LAMP assay, the Eiken Loopamp\u2122 MALARIA Pan Detection kit, is sensitive for Plasmodium falciparum and Plasmodium vivax , but has not previously been evaluated for P. knowlesi . This study aims to determine the sensitivity of this LAMP assay for detecting P. knowlesi infection.
Methods
Study participants included 73 uncomplicated malaria patients with PCR species confirmation: 50 P. knowlesi , 20 P. falciparum and 3 P. vivax . Nineteen malaria-negative, non-endemic area controls were also included. The sensitivity of the Eiken Loopamp\u2122 MALARIA Pan Detection kit (Pan LAMP) for detecting each Plasmodium species was evaluated. Sensitivity and specificity of the Eiken Loopamp\u2122 MALARIA Pf Detection kit ( Pf LAMP) for P. falciparum were also determined. The limit of detection for each LAMP assay was evaluated, with results compared to PCR. All P. knowlesi patients were also tested by CareStart\u2122 (Pf/VOM) and OptiMAL-IT\u2122 (Pan/Pf) RDTs.
Results
The sensitivity of the Pan LAMP assay was 100% for P. knowlesi (95% CI 92.9\u2013100), P. falciparum (95% CI 83.2\u2013100), and P. vivax (95% CI 29.2\u2013100). The Pf LAMP was 100% sensitive and specific for P. falciparum detection, with all P. knowlesi samples having a negative reaction. LAMP sensitivity was superior to both RDTs, with only 10 and 28% of P. knowlesi samples testing positive to CareStart\u2122 and OptiMAL-IT\u2122, respectively. Limit of detection using the Pan LAMP for both P. knowlesi and P. vivax was 2\ua0parasites/\u3bcL, comparable to PCR. For P. falciparum both the Pan LAMP and Pf LAMP demonstrated a limit of detection of 20\ua0parasites/\u3bcL.
Conclusions
The Eiken Loopamp\u2122 MALARIA Pan Detection kit is sensitive for detection of P. knowlesi in low parasitaemia clinical infections, as well as P. falciparum and P. vivax. However, a P. knowlesi -specific field assay in a simpler format would assist correct species identification and initiation of optimal treatment for all malaria patients
Pasteurized autograft reconstruction after resection of periacetabular malignant bone tumours
No full textAbstract
Background
The treatment of periacetabular malignant bone tumours is challenging. Many methods of reconstruction after internal hemipelvectomy have been reported and each method has its own limitations. The aim of this study was to evaluate the oncological and functional outcomes of pasteurized autograft reconstruction after resection of periacetabular malignant bone tumours.
Methods
Ten patients (six male, four female) with periacetabular malignant tumours, who underwent resection and reconstruction with pasteurized autograft, were retrospectively reviewed. The patients\u2019 average age at diagnosis was 40\ua0years (range 13\u201365\ua0years). There were five patients with chondrosarcoma, three with osteosarcoma, one with Ewing\u2019s sarcoma, and one with solitary metastatic thyroid carcinoma.
Results
At the last follow-up, seven patients were alive (six with no evidence of the primary disease and one with lung metastasis for 5\ua0months). The three other patients died of metastasis of the primary disease with a mean survival time of 12 (range 8\u201317) months postoperatively. The mean follow-up time for all patients was 45 (range 8\u201387) months. Local recurrence rate was 10%. The mean time of bone union was 12 (range 6\u201321) months after the operation. The mean Musculoskeletal Tumor Society score for all living patients at the last follow-up was 70.5% (range 43.3\u201386.7%).
Conclusions
Reconstruction with pasteurized autograft is a feasible method for treating periacetabular malignant bone tumours, with satisfactory oncological and functional outcomes and a relatively low incidence of complications
Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union
No full textAbstract
Background
Women\u2019s participation in medicine and the need for gender equality in healthcare are increasingly recognised, yet little attention is paid to leadership and management positions in large publicly funded academic health centres. This study illustrates such a need, taking the case of four large European centres: Charit\ue9 \u2013 Universit\ue4tsmedizin Berlin (Germany), Karolinska Institutet (Sweden), Medizinische Universit\ue4t Wien (Austria), and Oxford Academic Health Science Centre (United Kingdom).
Case
The percentage of female medical students and doctors in all four countries is now well within the 40\u201360% gender balance zone. Women are less well represented among specialists and remain significantly under-represented among senior doctors and full professors. All four centres have made progress in closing the gender leadership gap on boards and other top-level decision-making bodies, but a gender leadership gap remains relevant. The level of achieved gender balance varies significantly between the centres and largely mirrors country-specific welfare state models, with more equal gender relations in Sweden than in the other countries. Notably, there are also similar trends across countries and centres: gender inequality is stronger within academic enterprises than within hospital enterprises and stronger in middle management than at the top level. These novel findings reveal fissures in the \u2018glass ceiling\u2019 effects at top-level management, while the barriers for women shift to middle-level management and remain strong in academic positions. The uneven shifts in the leadership gap are highly relevant and have policy implications.
Conclusion
Setting gender balance objectives exclusively for top-level decision-making bodies may not effectively promote a wider goal of gender equality. Academic health centres should pay greater attention to gender equality as an issue of organisational performance and good leadership at all levels of management, with particular attention to academic enterprises and newly created management structures. Developing comprehensive gender-sensitive health workforce monitoring systems and comparing progress across academic health centres in Europe could help to identify the gender leadership gap and utilise health human resources more effectively
Screening for pickiness \u2013 a validation study
No full textAbstract
Picky eating is prevalent in childhood and is associated with negative health outcomes. Therefore early detection of pickiness is pertinent. Because no psychometric measure of picky/fussy eating has been validated, we aimed to examine the screening efficiency of the 6-item \u2018Food Fussiness\u2019 (FF) scale from the Children\u2019s Eating Behavior Questionnaire using structured psychiatric interviews (the Preschool Age Psychiatric Interview), providing meaningful cut-off values based on a large, representative sample of Norwegian 6\ua0year olds ( n \u2009=\u2009752). Screening efficiency was evaluated using receiver operating characteristic curve analysis, revealing excellent discrimination. The cut-point maximizing the sum of sensitivity and specificity for the scale was found at a score of 3.33 for severe cases and 3.00 when both moderate and severe pickiness were included. The results suggest that the FF scale may provide a tool for identification of clinically significant picky eating, although further assessment may be needed to separate moderate from severe cases
Temporal eating patterns: a latent class analysis approach
No full textAbstract
Background
There is some evidence that large energy intakes towards the end of the day are associated with adverse health outcomes, however, studies of temporal eating patterns across the day are rare. This study examines the temporal eating patterns of Australian adults using latent class analysis (LCA), as a novel approach.
Methods
Dietary data ( n \u2009=\u20092402 men and n \u2009=\u20092840 women, \u226519\ua0years) from two 24-h recalls collected during the 2011\u201312 Australian National Nutrition and Physical Activity Survey were analyzed. LCA was performed to identify distinct temporal eating patterns based on whether or not an eating occasion (EO) occurred within each hour of the day. F and adjusted-chi
2
tests assessed differences in sociodemographic and eating patterns (e.g., meal, snack and EO frequency) between latent classes.
Results
Three patterns, labelled \u201cConventional\u201d (men: 43%, women: 41%), \u201cLater lunch\u201d (men: 34%, women: 34%) and \u201cGrazing\u201d (men: 23%, women: 25%) were identified. Men and women with a \u201cGrazing\u201d pattern were significantly younger ( P \u2009<\u20090.001) and a higher proportion were from major cities ( P \u2009<\u20090.01) and were not married (men only, P \u2009=\u20090.01), compared to the \u201cConventional\u201d and \u201cLater lunch\u201d patterns. The \u201cGrazing\u201d pattern was also characterized by a higher EO frequency ( P \u2009<\u20090.01) and snack frequency ( P \u2009<\u20090.001) and consumption of a higher proportion of total energy intake from snacks but a lower proportion of total energy intake from meals ( P \u2009<\u20090.001).
Conclusions
This study identified three distinct temporal eating patterns in adults that varied by age, EO frequency, snack frequency and energy intake pattern. LCA is a useful approach to capture differences in EO timing across the day. Future research should examine associations between temporal eating patterns and health